decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
OIG Investigation Procedures / Investigation of Servicess Not Provided as Claimed / Cases Agents Will Not Consider
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Article Overview
This article summarizes a narrow OIG investigation topic focused on cases agents will not consider. It is useful for compliance staff, investigators, auditors, and coding professionals who need a high-level understanding of how certain investigation matters are screened and what general categories may be excluded from consideration.
Why This Topic Matters
Understanding the boundaries of case screening can help compliance and investigative teams assess whether a matter is likely to be reviewed by the OIG and whether it belongs in another enforcement path.
What You Will Learn
- The general categories of cases that are outside the scope of consideration in this OIG investigation topic.
- How case screening limitations are framed at a high level for compliance and investigative review.
- The kinds of broad conditions that may affect whether a matter is pursued through an OIG investigation.
- The overall relevance of these procedures to compliance and fraud/abuse screening.
Who Should Read This
- Compliance officers
- Medical coders
- Auditors
- Investigators
- Revenue integrity staff
- Healthcare administrators
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