On October 31, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) published the Work Plan for fiscal year (FY) 2015. The Work Plan outlines new and continuing OIG operations and reviews. The OIG will review entities such as hospitals, nursing homes, hospices and home health agencies. Examples of Work Plan items for FY 2015 include:
- New inpatient admission criteria;
- Medicare oversight of provider-based status;
- Duplicate graduate medical education payments;
- Outpatient evaluation and management services billed at the new-patient rate;
- Oversight of hospital privileging;
- Questionable billing patterns for Part B services during nursing home stays;
- Hospice general inpatient care;
- Home health prospective payment system requirements;
- Diagnostic radiology-medical necessity of high-cost tests; and
- Selected independent clinical laboratory billing requirements.
Providers should examine the OIG Work Plan and review risk areas that may instigate OIG enforcement actions.
The 2015 OIG Work Plan is available at:
Department of Health and Human Services Office of Inspector General. “Work Plan for Fiscal Year 2015.” Work Plan. 31 Oct. 2014.