decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
OIG Investigation Procedures / Administrative, Civil and Criminal Sanctions / Administrative Sanctions for Health Care Providers / Referral to State Licensing Boards or Medical-Professional Societies
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Article Overview
This premium article covers OIG investigation procedures related to administrative sanctions for health care providers, with a focus on referral of suspected unprofessional, unethical, or improper conduct to state licensing boards, medical boards, peer review organizations, or professional societies. It is relevant to compliance, auditing, and provider oversight professionals who need a general understanding of how these referrals fit into OIG sanction considerations and review reporting expectations.
Why This Topic Matters
It helps readers understand the role of external review bodies in the OIG sanction process and the types of provider conduct that may trigger referral and further disciplinary review.
What You Will Learn
- How OIG investigation findings may be referred to outside review and licensing entities.
- What general types of provider conduct may prompt referral for review.
- How peer review input can factor into sanction considerations.
- Why review decisions should be communicated in terms understandable to non-specialists.
Who Should Read This
- Compliance professionals
- Medical coders
- Healthcare auditors
- Revenue cycle staff
- Provider credentialing teams
- Healthcare attorneys
- Practice managers
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