Enforcement: Data Analysis Drives OIG's Biggest Takedown Ever

Subscribe or sign in to view the full article.

articles:   
Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article reviews an OIG Semiannual Report to Congress and highlights the agency’s enforcement focus during fiscal year 2017. It covers broad trends in fraud detection, recovery efforts, criminal and civil actions, exclusions from federal healthcare programs, and several headline enforcement matters involving opioids, home health, and electronic health record vendors. It is relevant to healthcare compliance, revenue integrity, and coding/billing professionals who follow program integrity enforcement and Medicare/Medicaid oversight.

Why This Topic Matters

It shows how federal oversight agencies use data analysis and program integrity initiatives to identify risk areas in Medicare and Medicaid billing and related conduct. Readers in compliance, billing, and practice management can use it to understand the enforcement landscape and the types of issues attracting government attention.

Article Sections

  1. OIG enforcement overview and FY 2017 results

    Summarizes the agency’s reported enforcement activity, recoveries, criminal and civil actions, and exclusions during the fiscal year. The section frames the overall program integrity environment described in the report.

  2. Opioid-related takedown and related enforcement

    Describes the large multi-agency enforcement action focused on opioid-related fraud and other drug-related misconduct. The section also notes broader opioid enforcement efforts referenced in the report.

  3. Additional enforcement examples

    Provides a sampling of other cases highlighted in the report, including home health, electronic health record vendor, and prescription-drug enforcement matters. The section emphasizes the variety of conduct discussed in the report.

What You Will Learn

  • How the OIG describes its use of data analysis and oversight tools in enforcement efforts
  • What broad categories of enforcement activity were reported for fiscal year 2017
  • Which major program integrity themes were highlighted in the report
  • What kinds of healthcare sectors were featured in the article’s enforcement examples

Who Should Read This

  • Healthcare compliance professionals
  • Medical billing and coding professionals
  • Revenue integrity teams
  • Practice managers
  • Healthcare attorneys
  • Fraud, waste, and abuse analysts

Subscribe or sign in to view the full article.

articles:   

Keep pace with evolving Medicare regulations — and onboard your team — with timely analysis of critical updates interpreted in an easy-to-follow, easy-to-apply format. Your subscription to TCI's Medicare Compliance & Reimbursement Alert will equip you to navigate code and guideline changes, CCI edits, and revisions to modifiers, payer policies, the fee schedule, OIG target areas, and more.

  • Current newsletters added each month
  • Fully searchable archives - over 4200 articles
  • ALL years/issues back to 2003 organized by year and issue
  • Codes mentioned in articles are linked to Code Information pages
  • Code Information pages link back to related articles

This feature is currently unavailable for online purchase. For more information, please call 801-770-4203 or Contact Us.

demo
request yours today
 subscribe
start today
 newsletter
free subscription

Thank you for choosing Find-A-Code, please Sign In to remove ads.

Aimee- AI -powered coding assistant - Try it now for Free Would you like Aimee - AI
to help you with this?