OIG Releases Semi Annual Report to Congress

The OIG has issued their Semi Annual Report to Congress for the period, October 1, 2020 through March 31, 2021. The Spring 2021 Semi Annual Report to Congress highlights nearly $2 billion in expected investigative and audit recoveries identified in just the first reporting period of FY 2021. The report details the OIG’s ongoing work through investigations and enforcement actions which include:

  • $566 million in recoveries from audits
  • $1.37 billion in expected investigative recoveries
  • 221 criminal actions
  • 272 civil actions
  • 1,036 excluded individuals

The OIG has heavily focused on COVID related issues such as fraud schemes, but audit activities of other areas have continued.  The types of issues identified that contributed to the nearly $2 billion in expected recoveries include:

  • Over-reporting of hospital inpatient stays at the highest DRG level
  • Billing for services that exceeded coverage limitations
  • Billing for services that did not comply with Medicare billing requirements, such as critical care
  • Prescribing medically unnecessary items
  • Upcoding of services
  • Payment for ineligible beneficiaries
  • Services provided by ineligible providers, such as physical therapy
  • 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
  • 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.

DISCLAIMER:  This newsletter contains only summary information and highlights; it should be read in conjunction with the full article or document provided as a link.  Any advice or recommendations are general and specific questions should be directed to professional counsel

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