The Office of Inspector General (OIG)

April 14th, 2017 - Chris Woolstenhulme, CPC, CMRS

Categories: Compliance

The Office of Inspector General (OIG) has the responsibility to identify and detect fraud, waste, and abuse for the United States Department of Health and Human Services (HHS) (also known as the Health Department). The mission of the U.S. Department of Health and Human Services is to enhance and protect the well-being of all Americans. The OIG cconducts criminal, civil, and administrative investigations of allegations of wrongdoing regarding HHS programs or HHS beneficiaries.

The purpose is to identify opportunities to improve program economy and to protect the integrity of the U.S. Department of Health and Human Services (HHS) program. The OIG will hold accountable anyone not meeting program requirements, or anyone that violates Federal healthcare program laws. Federal and State agencies will generally send referrals to the OIG for exclusion. The OIG states “In 2016 OIG excluded 3,635 individuals and entities from participation in the Federal healthcare programs.”

A Federal healthcare program is defined as a plan or program providing health benefits that is funded by the United States Government or a State healthcare program (this does not include Federal Employees Health Benefits).

The OIG web site reports, “HHS OIG is the largest Inspector General’s office in the Federal Government, with approximately 1,600 dedicated to combating fraud, waste, and abuse and to improving the efficiency of HHS programs.”

The Office of Audit Services (OAS) provides all auditing services for HHS.

The Office of Evaluation and Inspections (OEI) generally focuses on identifying instances in which the management of large HHS programs can be improved to increase the well-being of beneficiaries or to save Federal health care dollars.

Office of Counsel to the Inspector General (OCIG) represents OIG in all civil and administrative fraud cases.

Acronyms and Departments of the OIG

OIG	Office of Inspector General
HHS	U.S. Department of Health & Human Services (HHS)
OAS	The Office of Audit Services (OAS)
OEI	The Office of Evaluation and Inspections (OEI)
OI	The Office of Investigations (OI)
OCIG	The Office of Counsel to the Inspector General (OCIG)
EM	Executive Management (EM)
LEIE	List of Excluded Individuals and Entities (LEIE)

Understanding OIG’s Program Exclusions

Any individual or entity can be excluded, and reinstatement is NOT automatic. If and entity is excluded and wishes to participate again they must apply for reinstatement.

https://oig.hhs.gov/compliance/provider-compliance-training/files/HandoutExclusionTips508.pdf

Exclusions list (LEIE)

With the authority to exclude individuals and entities from Federally funded health care programs, anyone who hires an individual or entity on the LEIE may be subject to civil monetary penalties.

OIG imposes exclusions under the authority of sections 1128 and 1156 of the Social Security Act. For a complete list of mandatory and permissive exclusions, visit the Exclusion list of authorities. https://oig.hhs.gov/exclusions/authorities.asp

Online Searchable Database

Search for multiple individual, a single entity, or multiple entities.

https://exclusions.oig.hhs.gov/

Download the LEIE Database

https://oig.hhs.gov/exclusions/exclusions_list.asp

OIG Most Wanted Fugitives

https://oig.hhs.gov/fraud/fugitives/index.asp

OIG 2017 Work Plan

The OIG work plan will set forth projects that will be addressed during the fiscal year by the office of Audit Services (OAS). Work planning is a constantly evolving process and is updated throughout the year in order to meet any priorities in an effort to anticipate and respond to emerging issues with current resources available. Due to a continual update on the Work Plan, there are not status reports or the progress of reports. Contact public.affairs@oig.hhs.gov for questions.

https://oig.hhs.gov/reports-and-publications/archives/workplan/2017/HHS%20OIG%20Work%20Plan%202017.pdf

The OIG Compliance Plan Guidance

Voluntary compliance plan guidance is posted on the Federal register from the OIG and made available to the public. For instance, the Federal Register notices issued compliance program guidance for Individual and Small Group Physician Practices developed by the OIG and are made available to the public and developed as voluntary compliance plan guidance. With detailed information on the elements for an effective compliance program, the OIG has identified fundamental elements to an effective compliance program for different types of entities and risk areas and assessments.

###

Questions, comments?

If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.

Latest articles: (any category)

Artificial Intelligence in Healthcare - A Medical Coder's Perspective
December 26th, 2023 - Aimee Wilcox

We constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities?

Specialization: Your Advantage as a Medical Coding Contractor
December 22nd, 2023 - Find-A-Code

Medical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.

ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD)
December 19th, 2023 - Aimee Wilcox

Chronic respiratory disease is on the top 10 chronic disease list published by the National Institutes of Health (NIH). Although it is a chronic condition, it may be stable for some time and then suddenly become exacerbated and even impacted by another acute respiratory illness, such as bronchitis, RSV, or COVID-19. Understanding the nuances associated with the condition and how to properly assign ICD-10-CM codes is beneficial.

Changes to COVID-19 Vaccines Strike Again
December 12th, 2023 - Aimee Wilcox

According to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.

Updated ICD-10-CM Codes for Appendicitis
November 14th, 2023 - Aimee Wilcox

With approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.

COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli

COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.

Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli

2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....