Medicare Compliance & Reimbursement

The OIG offers a peek at its priorities for the coming 12 months

Exclusion from Medicare and Medicaid - a powerful weapon in the HHS Office of Inspector General's fraud enforcement arsenal - remains a big threat for health care providers who don't take their compliance programs seriously.

In its Work Plan for fiscal year 2004 - which begins Oct. 1 - the OIG predicts that it will oust "several thousand" wayward providers and suppliers from federal health care programs. The watchdog agency says it also plans to continue its work aiding the Department of Justice in False Claims Act cases, conducting site visits on providers bound by corporate integrity agreements and pursuing other fraud and abuse enforcement measures.

The Work Plan - essentially a compendium of the agency's anticipated activities for the coming year - lists dozens of new audits and investigations in the works, from a review of claims for coronary artery stents to a study of whether providers are using modifier -25 appropriately.

But drugmakers and nursing homes appear to be high on the OIG's priority list. In the report, the agency cites "pharmaceutical fraud" as an "investigative focus area" and warns that it will "increase its attention to quality of care issues for beneficiaries residing in care facilities."

To see the work plan, go to http://oig.hhs.gov/publications/docs/workplan/2004/Work%20Plan%202004.pdf.