OIG targets hospital-owned physician practices

Why This Topic Matters

Healthcare organizations and billing teams can use this overview to understand which practice arrangements and claims patterns are drawing federal audit attention. It highlights the types of coding and billing areas that may warrant internal compliance review.

Article Sections

1. Hospital-owned physician practices and provider-based designation

   Discusses OIG attention to hospitals that have acquired physician practices and how related outpatient payment arrangements are being reviewed.

2. Unlisted code procedures

   Summarizes the OIG’s interest in usage patterns involving unlisted procedures and broader payment trends.

3. Medicare claims with the GY modifier

   Covers OIG review of claims involving a specific Medicare modifier and associated claims patterns and trends.

4. Other familiar Work Plan entries

   Introduces additional recurring audit topics from the work plan affecting physician office, outpatient, and surgical billing areas.

5. Physician place of service coding

   Addresses OIG scrutiny of place-of-service reporting in certain outpatient settings.

6. E/M services billed during the global surgical period

   Reviews OIG interest in evaluation and management services reported during global surgical periods.

7. "Incident-to" services

   Covers OIG review of non-physician performance of services and related compliance considerations.