OIG Work Plan

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Jumpstart Your Compliance Program

The beginning of the New Year is a popular time for new initiatives. Many healthcare organizations are looking for ways to improve quality and reduce risk. A compliance program is an effective way to detect, deter and prevent wrongdoing in the healthcare setting and an ongoing system assures conformity with governing laws and regulations. An


The Office of the Inspector General (OIG) is responsible for protecting the integrity of the programs in Health and Human Services against fraud, waste and abuse as well as recommending improvements to the system that would promote efficiency and efficacy within the limits of the health care laws.   Although OIG oversight includes programs such as

Overview of a Corporate Integrity Agreement (CIA)

Health care fraud recoveries for fiscal years 2009- 2014 exceeded previous records with five straight years of more than $2 billion in annual recovery from cases involving fraud and false claims against federal health care programs such as Medicare and Medicaid.  Most healthcare providers are aware of significant civil liability due to recent enforcement. However,

Have You Reviewed the OIG 2015 Workplan?

The 2015 Workplan of the Office of the Inspector General highlights important areas for providers including medical necessity of services billed, payment review, exclusions, and incentive payments. Determination of the medical necessity of services billed is a primary focus of the Workplan. As stated in the Social Security Act, Medicare will not pay for items

Have you reviewed the focus areas in the 2014 OIG Workplan?

As part of the Health Care Fraud Prevention and Enforcement Action Team’s success, the Medicare Fraud Strike Force teams will continue to report potential fraud to the OIG.  Payment suspensions may occur while the investigation of credible fraud allegations proceeds.  CMS focuses on false claims related to inappropriate coding, performance of medically unnecessary services, quality-of-care

What Is the OIG List Of Excluded Individuals and Entities (LEIE)?

According to the OIG’s “Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse”, the OIG is legally required to exclude individuals and entities from all Federal healthcare programs who have been convicted of the following criminal offenses: 1. Medicare or Medicaid fraud or offenses related to delivery of items or services under Medicare