decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
OIG Investigation Procedures / Exclusion of Providers for Quality of Care Issues / Identification of Potential Quality of Care Cases
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Article Overview
This article explains how OIG field offices gather and review information about providers or companies with reported quality-of-care concerns. It is relevant to compliance, health care administration, and fraud-and-abuse oversight professionals who need a high-level understanding of the types of situations that may trigger review and possible exclusion.
Why This Topic Matters
Quality-of-care concerns can affect provider status, compliance risk, and oversight actions. Understanding the general categories OIG considers helps organizations recognize when internal review, documentation, or corrective action may be important.
What You Will Learn
- How OIG field offices gather information about potential quality-of-care concerns
- What general categories of cases may be reviewed for possible exclusion
- How quality-of-care issues relate to broader provider oversight processes
- Why extended pre-payment review can be associated with quality-of-care scrutiny
Who Should Read This
- Compliance professionals
- Health care administrators
- Revenue cycle staff
- Medical practice managers
- Coding and billing oversight personnel
- Risk management teams
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