With fraud and abuse enforcement in healthcare already reaching a high-water mark, HHS' Office of the Inspector General revealed plans for 2012 that call for even closer scrutiny of the massive industry (PDF).
Inspector general plans stepped-up oversight
Among the new actions announced by the inspector general's office is an effort to review hospitals deemed “high risk” to submit improper bills to Medicare, according to the 165-page 2012 work plan released Wednesday.
Inspectors plan to use data-mining techniques to review hospitals' submissions of certain billing codes, and then target hospitals with high use of those codes for focused reviews. The analysis will also be used to generate a list of high-risk hospitals, whose internal compliance programs will be compared with the policies in place at lower-risk hospitals to spot trends, the work plan says.
Meanwhile, other new initiatives of the department in 2012 will focus on proper documentation of patients' conditions at the time of admission. The plan says full and accurate documentation of “present-on-admission” indicators will become more critical in coming years as the department implements rules in the Affordable Care Act that withhold payments or even penalize hospitals when patients acquire new conditions while in the hospital.
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