OIG promises more in-depth anti-fraud efforts, further auditing of providers

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The Office of Inspector General may have delayed the announcement of its detailed 2014 annual Work Plan from October until January, but providers now know where the overall focus of investigative efforts will lie for the next four years. The OIG has announced it is committing to maximizing fraud recoveries and the protection of patient data for 2014-2018.

The investigative agency released its four-year strategic plan Thursday. It said it would “pursue all appropriate means to hold fraud perpetrators accountable and to recover stolen or misspent HHS funds.”

Such news is expected to be received tepidly by long-term care providers, who already are chafing from what they see as excessive post-payment audits of various government reimbursements. Skilled nursing providers receive at least 75% of their funding from two main government sources: Medicaid and Medicare.

The 2014-2018 OIG strategic plan comprises four extremely broad goals: fighting fraud, waste and abuse; promoting quality, safety and value; securing the future; and advancing excellence and innovation. More specific targets and projects for the year ahead are expected in January.

The OIG stresses in the four-year plan that it will continue to emphasize basing payments on value rather than quantity. It also commits to greater use of data analytics and technology fraud investigations and promotion of patient-record privacy.

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