OIG Updates Work Plan on Excluded Providers, Joint Work with States on Improper Payments

Situation Report | October 19, 2020

The U.S. Office of the Inspector General (OIG) has updated its Work Plan. 

HCA encourages members, especially compliance officers, to become familiar with key items in the OIG Work Plan. It highlights target areas for audits and, in turn, focus areas for your internal compliance planning.

Notable updates include:

  • Ineligible Providers in Medicare Part C and Part D: OIG will conduct a nationwide audit of Medicare Part C and Part D managed care data for calendar years 2018 and 2019 to identify ineligible providers that had been excluded, precluded, or deactivated as Medicare providers but provided services through Part C and D sponsors.  
  • Joint Work With State Agencies: OIG will partner with states to address known vulnerabilities that it has identified in both Medicare and Medicaid (address improper payments in fee-for-service programs such as home health, hospice, and durable medical equipment, and in managed care) to curb such vulnerabilities in Medicaid nationwide. OIG will also identify new areas that put the integrity of the Medicaid program at risk.