ED Coding & Reimbursement Alert - 2015 Issue 11
Compliance: OIG Revisits Recommendation to Pursue EHR Fraud
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Article Overview
This article reviews a March 2015 OIG compendium of unimplemented recommendations and highlights several compliance and program integrity issues affecting Medicare billing oversight. It discusses broad areas such as cumulative payment review thresholds, electronically enabled fraud risks in EHR systems, and efforts to improve overpayment identification and collection. The piece is aimed at compliance staff, coders, billing professionals, practice administrators, and other stakeholders who track audit risk and federal program integrity guidance.
Why This Topic Matters
It helps readers understand where federal oversight agencies are focusing attention, especially on documentation integrity, EHR-related fraud risks, and Medicare overpayment recovery efforts.
Article Sections
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Compendium of Unimplemented Recommendations
Introduces the OIG report and its focus on recommendations that have not yet been adopted. The section frames the article’s broader compliance and program integrity themes.
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EHR Fraud on the Table
Discusses electronic health record fraud vulnerabilities and related oversight concerns. It also addresses requested safeguards and agency-level responses related to EHR use.
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OIG Pursuing Overpayments
Summarizes the OIG’s concerns about Medicare overpayment identification and collection. The section describes the article’s emphasis on recovery efforts and contractor follow-through.
What You Will Learn
- How the OIG frames unimplemented compliance recommendations
- What broad EHR integrity concerns were highlighted by the OIG
- Why Medicare overpayment recovery remains a compliance priority
- Which federal entities are involved in responding to these recommendations
Who Should Read This
- Medical coders
- Billing specialists
- Compliance officers
- Practice administrators
- Revenue cycle teams
- Healthcare auditors
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