The Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) has been busy combating fraud and abuse over the last few years – the monies it has recovered more than doubled from 2006 to 2010, topping $4 billion in fiscal year 2010 alone. And OIG’s enforcement efforts will undoubtedly increase because of the balanced budget pressure in Washington.
With this in mind, the OIG’s recently released Work Plan for Fiscal Year 2012 provides the regulated community with a roadmap of the areas that will receive additional scrutiny from OIG. These include:
● Payment systems controls that identify high cumulative Part B payments made to physicians;
● Claim submission practices of, and private contracts entered into by, physicians who have opted out of Medicare;
● Physicians’ coding on Part B claims, for services performed in ambulatory surgical centers and hospital outpatient departments;
● Providers’ compliance with assignment rules relating to billings that exceed Medicare-allowable amounts; and
● Part B payments for chiropractic services.
This list only skims the surface of those “new” areas of OIG focus, and does not take into account its existing areas of investigation.
Moreover, these priorities also extend beyond fines and penalties and also cover exclusion of individuals from participation in federal health care programs. For instance, in fiscal year 2010, over 3,300 individuals and entities were excluded from such participation. A recent Government Accountability Office (GAO) report criticized HHS and suggested that it should be paying greater attention to its suspension and debarment programs, by perfecting its use of staff and developing guidance to implement these programs. Assuming HHS follows even some of these recommendations, we can also expect to see more suspensions and debarments in the coming year.