What the OIG’s Strategic Plan for 2014-2018 Means for Healthcare Organizations

What the OIG’s Strategic Plan for 2014-2018 Means for Healthcare Organizations

In November 2013, the Office of Inspector General (OIG) revealed its Strategic Plan for Fiscal Years 2014-2018 Earlier this year, the OIG issued a Special Advisory Bulletin (SAB) concerning exclusion screening and more recently issued a report recommending mandatory background screening of child care providers. But what can you expect in 2014 and beyond? Here’s a brief overview of the OIG’s plan for the next four years and how it may affect healthcare organizations. The Strategic Plan is comprised of four key goals.

1. Fight Fraud, Waste, and Abuse

Moving forward, the OIG will build on successful enforcement programs such as the Medicare Fraud Strike Force to improve its enforcement results in other programs. It will focus its efforts in two key areas: Medicare and Medicaid program integrity and waste in other Health and Human Services (HHS) programs. The Health Care Fraud and Abuse Control (HCFAC) program, for example, recovers more than $7 for every $1 invested and protects programs through nonmonetary results, such as criminal convictions and exclusions of providers from participation in federal healthcare programs. As a healthcare organization, it is important to review your operations and procedures for compliance with Federal requirements. It is important to assess whether providers, suppliers, grantees, and others are qualified to participate in government programs such as Medicaid and Medicare.

2. Promote Quality, Safety, and Value

The OIG will continue to evaluate and recommend improvements based on its reviews of adverse event, such as patient harm resulting from medical care, for example. In fact, it will also investigate and prosecute cases involving abuse or “grossly deficient care” of Medicare and Medicaid patients. In particular, the OIG plans to focus on promoting quality of care in nursing facilities and home- and community-based settings. It will continue to prioritize fraud investigations that have both public safety and financial implications, such as prescription drug fraud, for example. As a healthcare organization, ensuring quality of care and protecting patient safety are two objectives that resonate with the OIG’s Strategic Plan.

3. Secure the Future

The OIG conducts targeted reviews to identify improper payments to be recovered. For example, it conducts hospital audits identifying common billing and payment errors to recover funds that were overbilled to the government. Fortunately, the OIG will also provide healthcare organizations with recommendations to fix systemic weaknesses that contribute to improper payments. As HHS manages the transition to payments based on value rather than volume, the OIG plans to conduct reviews and provide recommendations to maximize overall value, protect program integrity, and promote value and high performance. The OIG will also look to data and technology as a means to drive improvements in healthcare and human services at lower costs. As a healthcare organization, it will remain important to safeguard the privacy and security of personally identifiable information as well as ensure the security and integrity of electronic health records.

4. Advance Excellence and Innovation

To meet its fourth and final goal, the OIG will continue to invest in its workforce. It will leverage technology and data analytics to make informed decisions on where to direct its resources. For example, by analyzing Medicare billing patterns, the Medicare Fraud Strike Force teams are able to uncover fraud and conspiracies in specific cases.