FY 2016 Work Plan Introduction

This review of the Office of Inspector General (OIG) CY 2016 Work Plan will provide the various section(s) that were identified by the OIG that may affect the specialty of Radiology. It does not include a comprehensive review of all components of the Work Plan. This document is for “informational use only” and it is not intended to provide legal advice or counseling on the various topic(s). If the reader has concerns or questions they should consult with their legal counsel for advice.

The OIG states that the purpose of the Work Plan is in part to provide brief descriptions of the activities the OIG intends to either initiate in FY 2016 or intends to continue from previous years as it exercises its oversight authority. The Work Plan is at its heart an allocation of resources to combat waste, fraud and abuse. How successful is the OIG in combating waste, fraud, and abuse? They reported for FY 2015 expected recoveries of more than $3 billion – $2.22 billion in investigative work and $1.13 billion in audit work.¹ Also reported for FY 2015 were 4,112 individuals excluded from participating in Federal healthcare programs, along with 925 criminal cases and 682 civil cases related to criminal activities, false claims and unjust-enrichment lawsuits.² 

This summary is presented in three sections:

  1. Medicare Parts A and B
  2. Medicaid
  3. CMS Related Legal and Investigative Activities

Under each section we provide the projects, as written by the OIG, that we believe to be of interest. Text emphasis was added to bring attention to the reason why the project was added. Some projects included are the OIG’s oversight of CMS, Medicare Administrative Contractors (MACs) and Medicare Advantage. These are included because it is expected they may be a catalyst for additional physician oversight from these entities. We encourage a review of the entire Work Plan.

No status reports or progress notes will be provided, however periodic updates are made to the Work Plan and will be available at www.oig.hhs.gov.

¹ Introductory Message from the Office of Inspector General, Work Plan Fiscal Year 2016. OIG, Department of Health and Human Services.
² Ibid.

Author - Female

About the author

Cathy Woodall, CHC, CPC is Compliance Director in Radiology of McKesson Business Performance Services