The OIG has issued their Semi Annual Report to Congress for the period, April 1 through September 30, 2020. The Fall 2020 Semi Annual Report to Congress highlights more than $4 billion in expected investigative and audit recoveries identified during FY 2020. The report details the OIG’s ongoing work through investigations and enforcement actions which include:
- $942 million in recoveries from audits
- $3.14 billion in expected investigative recoveries
- 624 criminal actions
- 791 civil actions
- 2,148 excluded individuals
The OIG has heavily focused on COVID related issues. However, audit activities of other areas have continued. The types of issues identified that contributed to the more than $4 billion in expected recoveries include:
- Prescribing medically unnecessary items
- Lab, DME, Home Health services ordered by ineligible providers
- Billing for non-skilled services as medically necessary rehab
- Performance of unnecessary laboratory tests like urinary testing
The following are areas that the OIG will likely continue to audit and that provider’s should continue to monitor carefully:
- Improper DRG coding for high risk diagnoses i.e. severe malnutrition
- Improper payments for post acute transfers and reporting of discharge status
- COVID-19 testing and telehealth services
We recommend you read the complete Semiannual Report along with OIG audit reports and the Work Plan to identify risks that are pertinent to your organization. Risk areas identified within this report and the Work Plan should be incorporated in to your auditing and monitoring efforts.
HBE’s team of experts is available to assist you with conducting risk assessments, routine auditing and monitoring, policy and procedure development as well as customized education and training for your clinical and administrative staff.