OIG Work Plan – FY 2009

health care lawLast week, the Office of Inspector General (OIG) published its “Work Plan” for federal fiscal year 2009. Many health care providers use the annual OIG Work Plan as a road map to guide their annual compliance efforts and this has always been a strategy that I have supported.

Although I usually suggest that compliance officers and the health care providers they represent look not just at the current year’s Work Plan but the past two or three years Work Plans, collectively, I think it is very important for health care providers to be aware of what the OIG thinks it should pay attention to, in any particular year. Its also noteworthy to understand how the OIG’s focus changes from year to year and over time.

Of particular note in this year’s Work Plan is the continuation of some significant reviews and the initiation of others that are in areas where health care providers often struggle.

They include OIG’s review of:

Provider-Based Status for Inpatient and Outpatient Facilities
Hospital Owned Physician Practices Billed as Outpatient Services
Provider Bad Debt Allocations
Medicare Secondary Payer Compliance
Diagnostic X-rays Performed in Hospital Emergency Departments
EMTALA Compliance
Never Events
Physician Services Performed by Non-Physicians
Medicare Payments for Sleep Services
Services Performed by Clinical Social Workers
Outpatient Physical Therapy Provided by Independent Therapists
Payments for Colonoscopy Services

Given some of the questions that I have received from clients in the past six months, I see EMTALA Compliance and Medicare Payments for Sleep Studies as particularly interesting and suggestive of the fact that OIG and CMS think that providers are not doing things correctly in these areas.

Your compliance committee should take the time to review the new OIG Work Plan and modify its compliance focus accordingly.