OIG Audits and Investigations: Get Ready for a Big Post-Pandemic Push

Things have been relatively quiet on the audit front during the COVID-19 public health emergency (PHE). But don’t be lulled into complacency. Right now, various agencies, including the Office of the Inspector General (OIG), are gearing up for a dramatic increase in audits and investigations as the pandemic winds down. Among the top targets for OIG auditors: DRG coding outliers that may signal fraud, waste or abuse. They’ll be taking an especially hard look at services provided via telemedicine, which increased significantly during the pandemic. While auditors will act to remedy many instances of overpayment, you can protect your revenues with the help of this RACmonitor webcast.

Former OIG senior special agent Eric Rubenstein will equip your organization to survive the blitz of post-pandemic audits and investigations. He’ll identify hot-button issues for auditors, how the OIG is using analytics to select facilities for reviews and proactive measures you can take to ensure fully compliant practices. With a clearer understanding of the analytics used by auditors, you’ll be empowered to implement more effective self-audit procedures and take the appropriate corrective action.

Why This is Relevant:

The pandemic pause on OIG audits and investigations is coming to an end. Will your organization be vulnerable to costly overpayment determinations? You need to understand what the auditors will be targeting, including the misuse of telemedicine services, mischaracterizations of COVID-19 patients and lack of documentation for sepsis diagnoses. Drawing upon his vast experience in federal law enforcement, Eric will help you see things from the auditor’s point of view, enabling you to take steps that reduce the risk of adverse action.

Learning Objectives:

• Understand the changing landscape of telemedicine — and why it should not be confused with telemarketing
• Learn about DRGs that are targeted as outliers, including one of the OIG’s top targets
• Become familiar with how data analysis is used in audits and investigations, plus how you can mirror some of these analytics
• Be able to communicate to other staff (subordinates, peers and supervisors) how the OIG requests medical records
• Learn how to apply target analytics to your compliance program

Who Should Attend:

Compliance and regulatory officers and other staff; hospital administrators; DRG audit staff administration; billing staff, audit defense teams; denials and appeals coordinators; physicians; and attorneys.