Compliance: Get Ready: See What New Target Areas Are in the OIG's Crosshairs for 2016

Why This Topic Matters

The article helps providers identify which operational and billing areas may face increased federal scrutiny in 2016 so they can prioritize compliance planning, documentation review, and internal auditing.

Article Sections

1. Hospitals: Your Quality Reporting is Under the Microscope

   Covers hospital-focused Work Plan items related to Medicare payment reviews, inpatient and outpatient billing oversight, and hospital quality reporting validation. It also addresses the hospital payment programs and data sources that may be reviewed.

2. Nursing Homes: Watch Your Therapy Billing Practices

   Summarizes planned scrutiny of skilled nursing facility payment practices under the prospective payment system, with emphasis on therapy-related billing, documentation, and compliance monitoring.

3. How Orthotic Braces are OIG’s ‘Prime Target’

   Discusses OIG attention to medical equipment and supply categories, including orthotic brace pricing questions, related device reviews, and Medicare Part B payment oversight for DMEPOS suppliers.

4. Prescription Drugs: Anticipate Scrutiny of 340B Program

   Describes OIG interest in prescription drug pricing and claims issues tied to the 340B program and Medicare Part D medication safety review topics.

5. Physicians & Other Providers: Prepare for a Variety of New Inquiries

   Covers a broad set of planned reviews affecting physicians, non-physician practitioners, ambulatory surgical centers, laboratories, ACOs, and CMS oversight of claims processing and implementation issues.