Recent additions to the OIG’s Work Plan

Revenue integrity professionals should take note of recent additions to the Office of Inspector General’s (OIG) Work Plan.

The OIG plans to review payment for hyaluronic acid knee injections, which are used to treat individuals with degenerative joint diseases such as knee osteoarthritis. The audit report is scheduled for release in 2025. 

Another recent addition to the OIG Work Plan involves payment for Part B items and services. These payments are generally based on a fee schedule or payment system instead of a cost or charge basis. Organizations’ billed charges often exceed these payments, and if there is a significant discrepancy between the two amounts, it can result in an overpayment.

In previous audits, the OIG determined that when a provider was paid more than it charged for a claim line, the claim line was often incorrect, leading to an overpayment. In response, the OIG plans to examine whether certain Medicare payments that exceed charges for Part B items and services were correct. The results of this audit are expected to be released in 2026.

Along with analyzing specific compliance issues, the OIG also plans to examine organizations and geographic areas with potentially limited response capabilities during the 2024 hurricane season. The audit results are expected to be released in 2025, and this information could help CMS minimize potential risks before, during, or following a hurricane event.

As the OIG prepares to take a closer look at these issues, organizations should be proactive and ensure their claims are in compliance with Medicare requirements. Keep an eye out for future additions to the OIG’s Work Plan, as they often indicate areas of noncompliance and revenue leakage.

Editor’s note: Find more NAHRI coverage of OIG audits and reports here.