The HHS Office of Inspector General (OIG) Work Plan for Fiscal Year 2012 provides brief descriptions of activities that OIG plans to initiate or continue with respect to HHS programs and operations in fiscal year 2012.
Physicians and Suppliers: Compliance With Assignment Rules
• Will review the extent to which providers comply with assignment rules and determine to what extent beneficiaries are inappropriately billed.
Physicians: Place-of-Service Errors
• Will review claims for services performed in ambulatory surgical centers and hospital outpatient departments to determine if POS was properly coded.
Part B Imaging Services: Medicare Payments
• Will review imaging services to determine expenses incurred and if utilization rates reflect industry practices.
Diagnostic Radiology: Excessive Payments
• Will review Medicare payments for high-cost diagnostic radiology tests and if medically necessary.
Laboratories: Part B Payments for Glycated Hemoglobin A1C Tests
• Will review contractors’ procedures for screening frequency of claims for glycated hemoglobin A1C tests. It is not considered reasonable and necessary to perform a glycated hemoglobin test more often than every 3 months.
Laboratories: Trends in Laboratory Utilization
• Will review trends in laboratory utilization under Medicare, such as in the types of laboratory tests and the number of tests ordered.
Payments for Laboratory TestsComparing Medicare, State Medicaid, and Federal Employee Health Benefit Programs
• Will determine how laboratory test payment rates vary from State Medicaid and FEHB programs.
Medicare Payments for Part B Claims with G Modifiers
• OIG will determine the extent to which Medicare paid claims having G modifiers where denial was expected.
Payments for Services Ordered or Referred by Excluded Providers
• Will review the extent of Medicare/Medicaid payments for services ordered or referred by excluded providers.
Recovery Audit Contractors’ Performance and Identification and Recoupment of Improper Payments
• Will review the performance of the RAC program and CMS’s oversight of the program.
Variation in Coverage of Services and Medicare Expenditures Due to Local Coverage Determinations
• Will review Medicare spending, monitoring and oversight of LCDs by contractors.
Comprehensive Error Rate Testing Program: Fiscal Year 2011 Error Rate Oversight
• Will evaluate CMS’s efforts to ensure the accuracy of the FY 2011 error rate and to reduce improper payments.
Medicaid National Correct Coding Initiative Effectiveness (New)
• Will review selected States’ implementation of NCCI edits for Medicaid claims.