OIG’s Work Plan for 2015

The Office of Inspector General (OIG) has published its Work Plan for Fiscal Year 2015 which describes OIG’s investigative priorities for 2015. The small health care provider needs to be familiar with the Work Plan to avoid coming up on OIG’s investigative radar.

With respect to Medicare Parts A, B, & D, OIG’s investigations will focus on:

  • hospital outlier payments;
  • new inpatient admission criteria;
  • billing for replacement of defective medical devices;
  • the extent to which provider-based facilities meet CMS criteria;
  • payment policy for swing-bed services at Critical access hospitals;
  • inpatient claims for mechanical ventilation;
  • overpayment for graduate medical education payments;
  • outpatient dental claims;
  • Part A billings by skilled nursing facilities;
  • Part B billings for services furnished during nursing home stays;
  • implementation of background checks of employees of long-term-care facilities or providers;
  • hospice services in assisted living facilities;
  • hospice general inpatient care;
  • compliance with various aspects of the home health prospective payment system;
  • home health care agencies’s employment of individuals with criminal convictions ;
  • billings by suppliers of power mobility devices,  lower limb prosthetics, nebulizer machines, and diabetes testing supplies (including blood glucose test strips and lancets);
  • payments to ambulatory surgical centers and end-stage renal disease facilities;
  • billings by ambulance services with a focus on medical necessity and level of transport;
  • chiropractic billings for non-covered Part B billings services ;
  • diagnostic radiology and imaging service billings;
  • ophthalmologists and  independent clinical laboratories billings;
  • physical therapists and high use of outpatient PT services;
  • sleep disorder clinics and the high use of sleep-testing procedures;
  • billings and payments for Part B prescription drugs, with a focus on immunosuppressive drug claims with KX modifiers and chemotherapy drugs;
  • enhanced screening of Medicare providers including site visits, fingerprinting and background checks.