Physician practices under OIG scrutiny: 3 tips to survive

The Office of Inspector General (OIG) has been busy lately, recovering a record-breaking $63 million in wasteful spending, particularly on Medicare payments for cardiovascular and musculoskeletal surgeries this fiscal year.

While recent crackdowns have focused on settings, including mental health centers, nursing homes and hospitals, physician practices are not immune from scrutiny.

According to the OIG's 2013 work plan, non-hospital-owned physician practices are on the agency's radar to determine whether their billing status, as provider-based physician practices results in additional Medicare payments and beneficiary coinsurance liability. This move is based on prior concerns from the Medicare Payment Advisory Commission about the financial incentives presented by provider-based status. MedPAC stated that Medicare should seek to pay similar amounts for similar services, the OIG noted.

Other items, such as Part B payments for chiropractic services, have made a recurring appearance in the work plan. According to an article from Dynamic Chiropractic, this means that the OIG's series of random reviews of chiropractic offices, which began last year, is expected to continue well into 2013.

"When you enroll in Medicare, you agree to oversight by the OIG," the article states, which is true for any medical practice. "This means that it has the right to enter your office and review any records it sees fit to review."

Thus, author Ronald Short, a certified insurance consultant, peer-review specialist and medical compliance specialist, offered the following tips for surviving OIG scrutiny of your office:

  • Don't attempt to explain to the OIG how your situation is unique, as it may result in even more intensive investigation. "Many simple reviews have turned into full-blown audits because the doctor tried to explain their situation," Short wrote.
  • Hire a consultant with expertise in the Medicare system who has experience working with the OIG and a qualified attorney, who will place the consultant under privilege. "This is very important because it allows you to be completely open with the consultant and prevents the OIG from compelling testimony from the person you hired to protect you," according to Short.
  • Appoint one staff member to work with the OIG and provide all of the records requested. "This prevents the OIG from having direct access to your files," Short wrote. The staff person should also copy each record requested by the OIG so the consultant and/or attorney might conduct a "shadow review" of the records in a harsh enough manner to determine the practice's worst-case scenario, he suggested.

To learn more:
- here's the OIG's work plan (.pdf) for 2013
- read the article from Dynamic Chiropractic

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