It's no secret that federal officials have been on the warpath as of late, cracking down on healthcare fraud, abuses, and waste, hoping for (and recently achieving) millions in recovered Medicare and Medicaid dollars. The Office of Inspector General (OIG) yesterday detailed next fiscal year's work plan for the Office of Audit Services, Office of Evaluation and Inspections, Office of Investigations, and Office of Counsel to the Inspector General, calling for continued attention to fighting healthcare fraud.
Among the work plan changes for hospitals regarding Medicare Parts A and B are the following:
Review of inpatient and outpatient payment to acute-care hospitals: Using computer-matching and data-mining techniques, OIG will select hospitals for focused review of their claims and policies and procedures to see if they follow billing requirements. Inspectors will interview those hospitals' leadership and compliance officers about their compliance programs. That information will be used for the goal of recovering overpayments.
Review of present-on-admission indicators submitted on Medicare claims: Inspectors will review the claims submitted in October 2008 by hospitals across the country, distinguishing hospital-acquired conditions from patient conditions at admission time.
Acute-care hospital inpatient transfers to inpatient hospice care: Inspectors also will look at Medicare claims for inpatient stays in which the patients were transferred to hospice care facilities.
Critical access hospitals: Inspectors will examine how many and what kind of patients critical access hospitals treat to determine the appropriateness of a CAH designation.
OIG identifies and prevents fraud, waste, and abuse in the 300 programs under Health & Human Services, including CMS, NIH, FDA, CDC, and the Administration for Children and Families. OIG receives thousands of complaints each year regarding potential fraud. It works with local and federal law enforcement, including the Federal Bureau of Investigation, the Internal Revenue Service, the United States Postal Inspection Service, and State Medicaid Fraud Control Unites, investigating individuals, facilities, and other entities that bill Medicare and/or Medicaid for services that are not provided or inappropriate, false or overestimated claims, as well as kickbacks and self-referrals.
In 2009, HHS and the Department of Justice created the Health Care Fraud Prevention and Enforcement Action Team, otherwise known as HEAT, which includes the Medicare Strike Force--an organization that most notably this year took down those responsible for $295 million worth of fraud in one fell swoop.
In fiscal year 2010, OIG investigations led to $3.8 billion in court-ordered or agreed on civil settlements and $1.1 billion in OIG audits, according to the report.
For more information:
- read the report's table of contents
- read the full OIG work plan (.pdf)
Physicians under alleged Halifax Health fraud paid over $1M
$205M Medicare fraudster gets longest sentence ever
BCBSNC exclusive: Overpayment allegations inaccurate
Hospital group fined $3.8M for alleged Medicare, Medicaid fraud
Feds unleash largest Medicare fraud takedown worth $295M