E/M Coding Alert - 2019 Issue 8
Enforcement: OIG Targets False Claims in New Report
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Article Overview
This article reviews highlights from an HHS Office of Inspector General semiannual report covering enforcement activity, recoveries, exclusions, and major fraud and abuse themes in federal healthcare programs. It is aimed at Medicare and Medicaid providers, compliance staff, auditors, and healthcare attorneys who want a high-level view of current enforcement priorities and the kinds of program vulnerabilities discussed in the report.
Why This Topic Matters
Understanding the OIG’s reported enforcement focus can help healthcare organizations assess compliance risk and stay alert to areas attracting audits, investigations, and fraud allegations.
Article Sections
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See the Major Target Areas
Summarizes the report’s discussion of enforcement themes, program vulnerabilities, and examples of cases involving federal healthcare programs. It also notes broad categories of misconduct and agency focus areas.
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Here’s How This Impacts Medicare Providers
Explains why the report may be useful to Medicare providers and compliance teams, with emphasis on monitoring government priorities and reviewing internal practices.
What You Will Learn
- What the OIG semiannual report covers at a high level
- Which broad enforcement and compliance areas are highlighted in the report
- Why the report may be useful for Medicare and Medicaid providers
- How providers and compliance teams can use oversight reports to assess risk
Who Should Read This
- Medicare providers
- Medicaid providers
- Compliance officers
- Healthcare attorneys
- Medical auditors
- Revenue cycle professionals
Codes Discussed
Modifiers Discussed
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