The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) Work Plan for fiscal year (FY) 2014 summarizes new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs and operations during the current fiscal year (FY) and beyond.
The OIG was created to protect the integrity of HHS programs and operations and the well-being of beneficiaries by detecting and preventing fraud, waste, and abuse; identifying opportunities to improve program economy, efficiency, and effectiveness; and holding accountable those who do not meet program requirements or who violate Federal laws. Their mission encompasses the more than 300 programs administered by HHS at agencies such as the Centers for Medicare & Medicaid Services (CMS), National Institutes of Health (NIH), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and Administration for Children and Families (ACF).
The majority of OIG resources are directed toward safeguarding the integrity of the Medicare and Medicaid programs and the health and welfare of their beneficiaries. Consistent with the responsibility to oversee all HHS programs, we also focus considerable effort on HHS’s other programs and management processes, including key issues such as food and drug safety, child support enforcement, conflict-of-interest and financial disclosure policies, and the integrity of contracts and grants management processes and transactions.
Some of the areas of review for 2014 that affect physicians and other providers include:
- Anesthesia services—Payments for personally performed services
- Chiropractic services—Portfolio report on Medicare Part B payments (new)
- Chiropractic services—Part B payments for noncovered services
- Chiropractic services—Questionable billing and maintenance therapy (new)
- Diagnostic radiology—Medical necessity of high-cost tests
- Electrodiagnostic testing—Questionable billing
- Evaluation and management services—Inappropriate payments
- Imaging services—Payments for practice expenses
- Laboratory tests—Billing characteristics and questionable billing
- Ophthalmologists—Questionable billing
- Partial hospitalization programs—Services in hospital outpatient departments and community mental health centers
- Physicians and suppliers—Noncompliance with assignment rules and excessive billing of beneficiaries
- Physicians—Place-of-service coding errors
- Physical therapists—High utilization of outpatient physical therapy services
- Portable x-ray equipment—Supplier compliance with transportation and setup fee requirements (new)
- Sleep disorder clinics—High utilization of sleep-testing procedures
For details of these and all other items on the OIG work plan, visit http://1.usa.gov/1qhQGDY
