The OIG – Segment I: An Introduction

by Applied Medical Systems

What is the OIG? The Office of the Inspector General, a part of the Department of Health and Human Services, was established in 1976 in order to combat waste, fraud, and abuse within Medicare, Medicaid, and other government services. Why is this important? Theft and waste of government money hurts- it hurts the beneficiaries who may not receive the services they need; it hurts the fiscal health of our great country; and it hurts you, the taxpayer who is left holding the bill. What is the OIG Work Plan? If the OIG tried to tackle every possible area within Medicare and Medicaid that is exposed to potential fraud and abuse all at once, the task would be insurmountable. Therefore, they target and audit specific sections that are thought to pose the highest risk. Each year, the OIG creates this Work Plan and publishes it so that providers of healthcare services will know what to focus on for their own internal auditing. Why would the OIG tell us what kinds of claims they are going to target? What’s the catch? The OIG knows that the vast majority of providers are honest, dedicated, and ethical, and truly do not want to perpetuate waste, fraud, or abuse of government funds. These providers are not the intended target of OIG investigation, and by publishing their goals for the year, the OIG provides these honest providers some of the tools needed to fix their own unintended errors. How does it affect me as a provider of service to government-funded beneficiaries? Every provider of healthcare service who receives government funds is at some risk for an OIG audit. Should I be worried? There’s no reason to worry... as long as you are conscientious in your recordkeeping and perform routine internal audits of your documentation and claims filing. However, in 2011, the OIG recovered $5.2 billion dollars through audit and investigation. I’m sure my records are in good order... but how can I tell if they’re not? Don’t wait to find out the hard way whether you are unintentionally over collecting from the government. Perform regular targeted internal audits to find and correct any potential weak spots. I need help! Where do I go? There are many tools to assist you in protecting yourself from a costly OIG Audit. Visit the OIG’s website at The OIG’s entire Work Plan for 2013 can be found at You can also check us out at for more helpful medical billing and coding tips, or contact us directly at [email protected]. Lastly, keep checking back- our blog will cover the most common OIG Hot Topics right here, so stay tuned!