OIG work plan: Find out where the HHS Office of Inspector General plans to focus investi-gations in 2005

Why This Topic Matters

The piece helps readers understand which Medicare billing and compliance areas were under OIG attention for 2005 so they can assess exposure, prepare compliance programs, and monitor operational changes tied to federal oversight.

Article Sections

1. Billing service company relationships

   Introduces the OIG’s interest in how physician practices and billing firms interact and the general compliance concerns tied to those arrangements.

2. Other new areas of focus in the 2005 work plan

   Summarizes additional oversight topics identified in the work plan and provides an overview of the types of Medicare payment and compliance reviews expected during the year.

3. Cardiography and echocardiography services

   Discusses review of payment and billing for diagnostic cardiac services and the associated component-level oversight focus.

4. Pathology services

   Covers physician and outside-entity relationships involving pathology-related services and the related compliance attention.

5. SNF services

   Addresses Medicare billing for services furnished in skilled nursing facilities and the concern about duplicate or inappropriate payment.

6. PECOS

   Describes the OIG’s review of CMS’s provider enrollment system and its interest in enrollment process performance and provider number management.

7. Wound care

   Summarizes planned review of wound care spending growth, medical necessity, and program controls related to payment integrity.

8. Average sales price drug payments

   Outlines OIG studies of oncology and hematology drug purchasing and reporting under Medicare drug payment methodology.

9. Progressive corrective action

   Explains that carriers’ use of progressive corrective action in medical review will be evaluated as part of the oversight work plan.

10. Provider-based entities

    Describes examination of provider-based status and compliance with Medicare requirements for certain facilities and services.