Each year, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) publishes a Work Plan for the coming fiscal year which summarizes new and ongoing reviews and activities that the OIG plans to pursue with respect to HHS programs and operations during the current fiscal year and beyond. For physicians and other providers seeking to gain insight on the types of compliance issues the OIG will be reviewing, the Work Plan is an important resource. The FY 2015 Work Plan, among other things, identifies the following initiatives related to physician and other non-institutional practitioner activities:

  • Anesthesia Services – A review of Medicare Part B claims for personally performed anesthesia services to determine whether they were supported in accordance with Medicare requirements, and to determine whether Medicare payments for anesthesia services reported on a claim with the “AA” service code modifier met Medicare requirements.
  • Chiropractic Services – A review of Medicare Part B payments for chiropractic services to determine whether such payments were claimed in accordance with Medicare requirements.
  • Diagnostic Radiology – A review of Medicare payments for high-cost diagnostic radiology tests to determine whether the tests were medically necessary and to determine the extent to which use has increased for these tests.
  • Ophthalmologists – A review of Medicare claims data to identify potentially inappropriate and questionable billing for ophthalmology services during 2012.
  • Physicians – A review of physicians’ coding on Medicare Part B claims for services performed in ASCs and hospital outpatient departments to determine whether they properly coded the places of service.
  • Physical Therapists – A review of outpatient physical therapy services provided by independent therapists to determine whether they were in compliance with Medicare reimbursement regulations.