The U.S. Department of Health and Human Services’ Office of the Inspector General (OIG) has outlined the areas where it anticipates focusing its investigative energies in 2015.

hhsOIGAmong the Medicare issues it plans to address next year are:

  • new hospital inpatient admission criteria
  • oversight of provider-based status
  • the appropriateness of indirect medical education (IME) payments
  • evaluation and management (E&M) coding practices
  • hospital controls over wage data used in the calculation of hospital Medicare area wage indexes

Among the Medicaid issues the OIG will examine are:

  • the accuracy of state eligibility determinations
  • quality of care, including access to preventive screenings for children
  • managed care organization practices, including claims for services delivered after patients’ deaths and payments made on behalf of beneficiaries who are not eligible for Medicaid

For an overview of the OIG 2015 plan, see this National Law Review article.  To see the plan itself go here, to the OIG’s web site.