OIG Work Plan for 2016

Home Health:

The OIG will be focusing again on compliance with documentation to support claims submitted and paid by Medicare.  Agencies should continue to review documentation standards and continue to educate staff on the proper methods of charting.  Using an electronic medical record helps, but can only go so far to protect your agency.

 

The OIG is also looking very closely at new agencies who have received their provider number.  The Inspector General estimates that based on prior review, new agencies are the most likely to commit fraud and participate in deemed fraud and waste activities.  The OIG went on to state that 1 in 4 home health agencies have questionable billing practices based on historical analysis.

 

Hospice:

Hospice providers need to take notice. The OIG clearly has set its sights on reviewing medical records to determine if the patient actually needs hospice as a skilled service and if the services are even medically necessary.   Plans of care will also be subject to review to see if they actually follow the care provided to patients.  Basically, the OIG is looking to see whether or not hospice services are needed at a certain stage in the patient’s condition.   So hospices that put patients on service in the early stages of their terminal illness, should be worried.

 

 

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