Why Does the OIG Work Plan Matter for Medical Practices?


July 26th, 2021 -
Andrew Fearnley
/ 8 Min Read

Andrew Fearnley

Senior Marketing Manager

OIG in healthcare

OIG is an acronym that stands for Office of Inspector General that was established in 1976. The office has been at the forefront in the fight against abuse, fraud, and waste, improving the efficacy of medical care, Medicaid, and more than 100 programs of the Department of Health and Human Services in the United States of America.

The OIG Work Plan Matters for medical practices as discussed below. OIG compliance program includes guidelines that have been put in place by the organization to encourage the development and the use of internal controls to monitor adherence to the applicable program requirements, statutes, and regulations. The OIG’s website gives a list of all the compliance program guidance documents.

What is OIG in Healthcare? 

Office of Inspector General (OIG) has led in the fight against abuse, fraud, and waste and improved the efficiency of Medicaid, Medicare, and more than 100 programs provided by the Department of Health and Human Services (HHS).

Therefore, OIG has a vital role in ensuring integrity and honesty in the healthcare institutions in the United States of America.

The OIG compliance program ensures that all the healthcare organizations in the United States of America follow all the standards that aim to provide:

  • Accountability
  • Honesty
  • Ethics
  • Improve the healthcare sector.

OIG fraud alerts are a unique way of informing the firms in the healthcare sector that the organization is aware of certain abusive practices that they are planning to pursue and prosecute or bring the civil and administrative action appropriately. 

Why is the OIG Work Plan Important? 

It is challenging to keep track of all the laws and guidelines that have been put in place to defend against potential abuse, waste, and fraud. The state and federal laws determine an effective compliance program that the healthcare industry has to focus on.

The healthcare regulation is not always permanent, and there is always a threat of healthcare reforms that comply with the laws that guide healthcare reforms to be tricky and confusing.

The stakeholders in the healthcare sector could fail to comply with the laws in one way or the other, leading to costly and time-consuming audits and sanctions.

The OIG Work Plan is important because it sets various projects that are supposed to be addressed during a given fiscal year.

The Office of Investigations, Office of counsel, Office of Evaluation and Inspections, and the Office of Audit Services to the Inspector General, including the CMS’s projects. It is, therefore, an essential document that helps various healthcare organizations in the healthcare sector. 

What is the focus of the OIG Work Plan?

Working day in office.
Working day in office.

The focus of the OIG work Plan is to reveal various projects that are supposed to be addressed during the fiscal year by the Office of Investigations, Office of counsel, Office of Evaluation and Inspections, and the Office of Audit Services to the Inspector General, including the projects that the CMS has planned.

The work plan sets goals and objectives that are supposed to be achieved in a given time, giving stakeholders an idea of what they are supposed to do regarding the guidelines that have been put in place by the OIG.

The work plan also assigns various stakeholders in the healthcare industry what they are supposed to do and how they are supposed to do it. 

The 2021 OIG Work Plan Updates you need to know. 

Several updates have been done on the OIG work plan, and the stakeholders in the healthcare industry are supposed to be well-versed with them.

The OIG keeps on changing the work plan, removing some sections, and adding some to improve it and make sure that it serves the purpose it is intended. 

1. COVID-19 Vaccination Program 

It could be easy for people to welcome an audit on the vaccination program at the beginning of the COVID-19 pandemic because that could mean that vaccines are available.

OIG is reviewing its efforts in the vaccination program, which is a good thing in the grand scheme of the pandemic.

The war on the COVID-19 pandemic can be won if the vaccines are effectively dispensed. Generally, it has always been the work of the state public health departments and the public health departments in the large metropolitan area to oversee distribution and the administration of the vaccines.

The CDC recommended that the entities have a chance to deal with the vaccines in the fight against the COVID-19 pandemic. Various challenges have been expected in the vaccination process as expected. That is why the OIG seeks to dissect the vaccination process and find the cause of the challenges experienced.

The OIG plans to interview all the entities awarded the privilege of distributing and dispensing vaccines to determine the challenges faced in the process.

They also ask the entities about the best mitigation strategies that they have identified that can deal with the challenges identified, the new challenges anticipated, and how the HHS can support them to distribute and dispense the COVID-19 vaccines effectively.

The Office of Inspector General hopes that this update will help HHS get timely and actionable information that will help them address the challenges associated with the COVID-19 vaccination efforts. 

2. Reviewing the use of opioids in 2020

The review in the United States of America is that the entire healthcare system in the country was only focused on the COVID-19 pandemic.

However, opioid use remains one of the biggest challenges to the healthcare system in the United States of America because approximately 47,000 people died of opioid-related overdose deaths in 2018.

The government has been keen on the fight against opioid-related deaths by identifying the likelihood to abuse or overdose the drug then help them out. The COVIID-19 pandemic has made it more pressing because the people addicted to opioid use may be at risk of contracting severe COVID-19. After all, the disease primarily attacks the lungs.

People taking opioids are at risk of suffering from respiratory diseases. This proposed OIG brief attempts to provide important information about the use of opioids among the beneficiaries that have been enrolled in Medicare Part D in the year 2020.

The data brief is expected to contain the number of beneficiaries that received an extreme amount of opioids through part D.

Data collected in the year 2020 about expenditure on opioids, data on those who were looking for medical care as a result of opioid addiction, and identification of the prescribers that ordered numerous opioids to be used by the beneficiaries.

The information is important in fighting opioid use in society, making sure that the drug is used appropriately, and following the prescription given by the doctor.

If your organization participated in these work plan items addressed above, you need to focus on your compliance program’s proactive efforts to ensure compliance and mitigate the risks. 

How OIG Helps healthcare providers avoid healthcare fraud 

Health Insurance Claim Form
Health Insurance Claim Form

The OIG plays an essential role in helping healthcare providers to avoid fraud. Most healthcare is ethical in their service delivery, and the legislators need to enact laws that will protect the public. The OIG prevents fraud by disqualifying Medicare and Medicaid reimbursements for the healthcare providers that engage in fraud.

The healthcare providers, therefore, become very vigilant in the fight against fraud.

The OIG has come up with voluntary compliance program guidance documents that are guided at various segments in the healthcare industry such as nursing homes, hospitals, and durable equipment suppliers to encourage them to develop internal controls that will help them monitor the program requirements regulations and statutes.

The regulations, statutes, and program requirements give information about fraud and how to fight it in society as a whole.

The OIG, therefore, sets up to fight fraud, puts the necessary regulations and statutes in place then helps the healthcare organizations with the ideas on what they can do to comply. 

Strong Compliance Plans for Small Medical Practices 

Various strong compliance plans have been put in place for small medical practices.

There are many laws that the healthcare organizations are supposed to comply with, failure to which they will face civil and criminal penalties. The laws include:

  • The False Claims Act
  • Anti-Kickback Statute
  • Stark Law
  • Health Insurance Portability and Accountability Act (HIPAA)
  • The Civil Monetary Penalties Law (CMPL)

The OIG recommends that the small group practices incorporate various recommendations in their voluntary compliance plan that include:

  1. Enforcing disciplinary standards
  2. Conducting internal monitoring and auditing 
  3. Designating a compliance officer or contact
  4. Implementing compliance and practice standards
  5. Coming up with open lines of communication 
  6. Responding to any offenses committed and coming up with the best corrective action
  7. Training and educating the stakeholders appropriately on compliance 

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