What is the role of the OIG in the healthcare industry?
It is essential that all providers who bill Medicare or Medicaid understand the role of the OIG, what OIG's investigation looks like, and how to survive an OIG audit. The OIG is responsible for investigating a wide range of civil and criminal healthcare fraud matters.
What is the difference between the CMS and the OIG?
While the CMS creates the rules healthcare professionals must follow, the OIG fills the investigatory (to detect fraud) and law enforcement role, initiating investigations into practices that the CMS or other federal agencies identify as non-compliant.
How does the OIG receive referrals?
In some cases, the OIG receives a referral through the OIG Hotline, which allows for any member of the public with knowledge of fraud or waste to make a referral. This is fairly common, as the False Claims Act provides a mechanism for referring parties to recover a portion of any damages recovered by the government.
What is the Office of Inspector General (OIG)?
Since its 1976 establishment, the Office of Inspector General (OIG) has been at the forefront of the Nation's efforts to fight waste, fraud and abuse and to improving the efficiency of Medicare, Medicaid and more than 100 other Department of Health & Human Services (HHS) programs.
What is the main function of OIG?
According to the Inspector General Act of 1978, as amended, the Inspector General's mission is to: Conduct independent and objective audits and investigations relating to DHS programs and operations. Promote economy, efficiency, and effectiveness in DHS programs and operations.
What does OIG cover?
OIG's LEIE provides information to the health care industry, patients and the public regarding individuals and entities currently excluded from participation in Medicare, Medicaid and all other Federal health care programs. Individuals and entities who have been reinstated are removed from the LEIE.
Who does the OIG oversee?
The OIG investigates alleged violations of criminal and civil laws by DOJ employees and also audits and inspects DOJ programs. The Inspector General, who is appointed by the President subject to Senate confirmation, reports to the Attorney General and Congress.
What is the function of the OIG within HHS?
Mission: OIG's mission is to provide objective oversight to promote the economy, efficiency, effectiveness, and integrity of HHS programs, as well as the health and welfare of the people they serve.
What is OIG compliance?
OIG compliance programs provide oversight toward promoting ethical and lawful corporate conduct that focus on encouraging prevention, detection and resolution of occurrences of conduct that do not meet federal and state law, and a hospital or health system's business policies.
What happens when OIG investigation?
Q: What happens when an investigation is complete? A: Generally, when an investigation is complete, OIG will produce a report based upon relevant witness interviews, records, and other evidence. The report will be reviewed within OIG to ensure that it is fact-based, objective, and clear.
What are the major responsibilities of the Office of the Inspector General as it relates to coded health care data?
conduct audits and investigations relating to all aspects of the agency's programs and operations. coordinate or recommend policies for agency activities and for relationships between NARA and other federal agencies to promote efficiency and prevent waste, fraud, abuse, and mismanagement.
What is an OIG report?
OIG reports contain findings of its audits and evaluations, assess how well HHS programs and grantees/contractors are working, identify risks to the people they serve and to taxpayers, and recommend necessary improvements.
What is OIG exclusion list?
Exclusions. The Office of Inspector General's List of Excluded Individuals/Entities (LEIE) provides information to the health care industry, patients and the public regarding individuals and entities currently excluded from participation in Medicare, Medicaid, and all other Federal health care programs.
What is a Medicare OIG audit?
Under this authority, OIG conducts audits of internal CMS activities, as well as activities performed by CMS grantees and contractors. These audits are intended to provide independent assessments of CMS programs and operations and to help promote economy and efficiency.
What does the OIG monitor?
OIG monitors and tracks the use of taxpayer dollars through audits, inspections, evaluations, and investigations. The Inspector General keeps the Secretary of Commerce and Congress fully and currently informed about problems and deficiencies relating to Commerce's activities and the need for corrective action.
What do the government agencies OIG CMS and Department of Justice enforce?
Criminal, civil or administrative legal actions relating to fraud and other alleged violations of law, initiated or investigated by OIG and its law enforcement partners.
What is OIG in healthcare?
The Office of the Inspector General, or OIG, is essential for healthcare employers. But, do you know how this search fits into a comprehensive background check, who to screen and when?
What is the purpose of OIG?
Instituted in 1976, its sole purpose is to protect HHS programs and the recipients of those programs. OIG focuses its energies into discovering and preventing fraud and abuse in hundreds of HHS programs such as the Food and Drug Administration or the Centers for Disease Control and Prevention as well as Medicare and Medicaid.
What is OIG background check?
OIG advises to screen individuals that perform a service or provide products which are payable by a Federal health care program. This includes potential contractors, subcontractors and employees. It is best practice for all healthcare agencies to administer a pre-employment background check for all healthcare positions that include ...
What is an OIG search?
An OIG Search identifies individuals or entities that have been excluded from participation in Medicare, Medicaid or other federal healthcare programs.
How many primary sources are there in the medical registry?
With over 2,500 primary sources, including OIG, and historical data dating back to 1992 as well as thousands of records added daily, you can rest soundly knowing you received the best possible medical registry search available.
Does CMS require a monthly screening?
OIG also makes it clear in their bulletin that CMS (Centers for Medicare and Medicaid Services) has recommended that all States consider establishing monthly screening requirement for all providers and contractors. This may be due to the fact that OIG updates their list on a monthly basis.
Does OIG require periodic rescreening?
OIG recommends screening an individual prior to employment, as well as periodic rescreening to determine exclusion status post hire. There are no regulatory constraints so it is up to the provider to determine the rate of rescreening.
What is OIG in healthcare?
To help healthcare providers such as hospitals and physicians comply with relevant Federal health care laws and regulations, OIG creates compliance resources, which are often tailored to particular providers.
What is the OIG?
The Office of Inspector General (OIG) for the U.S. Department of Health & Human Services has created the educational materials to assist in teaching physicians about the Federal laws designed to protect the Medicare and Medicaid programs and program beneficiaries from fraud, waste, and abuse.
What is OIG compliance?
OIG's compliance documents include special fraud alerts, advisory bulletins, podcasts, videos, brochures, and papers providing guidance on compliance with Federal health care program standards. OIG also issues advisory opinions, which cover the application of the Federal anti-kickback statute and OIG's other fraud and abuse authorities to ...
What does the Inspector General do?
The Inspector General occasionally issues letters to health care providers alerting them to OIG policies and processes; inviting them to engage in our anti-fraud initiatives; and updating them on our ongoing projects to fight fraud, waste, and abuse in Federal health programs.
The OIG Investigation Process
The OIG is responsible for investigating a wide range of civil and criminal healthcare fraud matters. While the OIG investigation process varies slightly depending on the allegations and how they are discovered, an investigation typically takes the following path:
Surviving an OIG Audit
The thought of an OIG audit is overwhelming to many healthcare providers. And for good reason, OIG audits are not only incredibly burdensome and invasive but also present very high stakes. Thus, providers must understand what they can do to protect themselves in advance of an audit as well as how to effectively respond if they are audited.
