News: OIG to audit telehealth claims and other COVID-19 programs

It used to come annually. Every October, compliance officers across the country would delve into its pages to determine what the Office of the Inspector General (OIG) planned to investigate for the coming calendar year—and what their facility’s risk level might be.

The OIG’s Works Plan—its blueprint for focus areas—now gets updated on an ongoing basis.  And the information it contains isn’t just relegated to the compliance officer’s desk. CDI programs need to stay informed about where the OIG plans to turn its investigative eye as some priorities, such as appropriate documentation and billing for malnutrition, for example, overlap with CDI efforts.

The most recent Work Plan release, titled “Medicare Telehealth Services During the COVID-19 Pandemic: Program Integrity Risks,” will “analyze providers’ billing patterns for telehealth services”  based on Medicare Parts B and C data to identify program integrity risks, so this may be an opportunity for those CDI programs assisting with outpatient or physician practice setting reviews. The OIG notes that they will also describe key provider characteristics or patterns that may pose a risk to Medicare. Telehealth claims made during the COVID-19 pandemic can expect to be audited under the new OIG Work Plan.

Editor’s note: The full OIG Work Plan list can be found here. The telehealth workplan can be found here. To read about CDI’s involvement with telehealth record reviews, click here. To read ACDIS’ coverage of the COVID-19 pandemic, click here.