About October each year, the Office of Inspector General (OIG) within the Department of Health and Human Services issues its annual Work Plan for the coming year. The plan describes the activities that OIG will focus on to protect the integrity of the federal health care programs.

In general, a review of relevant sections of the plan may help providers update internal compliance policies or develop new ones to address issues that likely will be targeted by the government for closer scrutiny.

For example, this coming year, OIG will study physician coding of place of service (“POS”) on claims for services performed in ambulatory surgical centers and outpatient departments versus a physician’s office. The concern is that physicians may be miscoding POS to realize higher reimbursement associated with services performed in a nonfacility setting.

Other examples, to name just a few, include studies of evaluation and management services during global surgery periods, services performed by independent physical therapists, appropriateness of payments for sleep studies, compliance with Medicare assignment rules, and payments for services ordered or referred by providers excluded from participation in the federal health care programs.

While the Work Plan is simply an overview document, it can be used as a tool by providers to hone their own compliance efforts. For OIG, it represents an updated roadmap for getting to more monetary recoveries in the federal health care programs.

In fiscal year 2008, the Health Care Fraud and Abuse Control Program reported that the federal government won or negotiated approximately $1 billion in judgments and settlements in cases and proceedings related to fraud and abuse in the federal health care programs. Even though billion is the new million today, that figure represents a significant compliance problem. Consequently, scrutiny of federal payments to providers will continue to be one of the primary risk areas for any internal compliance program.