The OIG Work Plan: What Is It and Why Should I Care?
This auditing and compliance “Tip of the Week” was originally published by the National Alliance for Medical Auditing Specialists (NAMAS), a division of DoctorsManagement.
Healthcare providers, organizations, compliance officers, and auditors should all keep abreast of the OIG’s audit targeting process by following the OIG’s Work Plan. In its own words, the OIG Work Plan “sets forth various projects including OIG audits and evaluations that are underway or planned to be addressed during the fiscal year and beyond by OIG’s Office of Audit Services and Office of Evaluation and Inspections.”  The OIG plans its work by assessing relative risks in various HHS programs and operations to identify areas it believes are in need of audit scrutiny. Once that’s done, priorities are set for the sequence and proportion of resources to be allocated. The work portfolio also includes several legal and investigative activities.
The OIG’s Active Work Plan Items can be found at https://oig.hhs.gov/reports-and-publications/workplan/active-item-table.asp. An item recently added to the work plan which impacts several of my personal clients was announced in June 2019 and is titled “Review of Medicare Part B Claims for Intravitreal Injections of Eylea and Lucentis.” This work plan item specifically pertains to ophthalmology practices and, if you click on the item in the work plan, you can find more information on what the OIG is specifically targeting. In this case, it states that “[OIG] will review claims for intravitreal injections of Eylea and/or Lucentis and the other services billed on the same day as the injection, including evaluation and management services, to determine whether the services were reasonable and necessary and met Medicare requirements.” 
The work plan is updated monthly and it “will evolve as OIG continues to pursue complete, accurate, and timely public updates regarding our planned, ongoing, and published work.” For anyone involved in healthcare, whether a provider or an auditor, it’s always good to have your finger on the pulse of what items and areas the government is actively auditing and investigating. If you’re not doing it already, the OIG Work Plan is a good resource and is worth a bookmark in your Internet browser.
HHS & DOJ Annual Fraud Report for FY 2018 https://oig.hhs.gov/publications/docs/hcfac/FY2018-hcfac.pdf
This Week’s Audit Tip Written By:
Jesse is a Senior Management Consultant and General Counsel for DoctorsManagement, LLC.
Here’s why thousands of providers trust DoctorsManagement to help improve their coding and documentation.
Quality of coders and auditors. Our US-based auditors receive ongoing training and support from our education division, NAMAS (National Alliance of Medical Auditing Specialists). All team members possess over 15 years of experience and hold both the Certified Professional Coder (CPC®) as well as the Certified Professional Medical Auditor (CPMA®) credential.
Proprietary risk-assessment technology – our auditing team uses ComplianceRiskAnalyzer(CRA)®, a sophisticated analytics solution that assesses critical risk areas. It enables our auditors to precisely select encounters that pose the greatest risk of triggering an audit so that they can be reviewed and the risk can be mitigated.
Synergy – DoctorsManagement is a full-service healthcare consultancy firm. The many departments within our firm work together to help clients rise above the complexities faced by today’s healthcare professionals. As a result, you receive quality solutions from a team of individuals who are current on every aspect of the business of medicine.