On October 2, 2012, the U.S. Department of Health and Human Services, Office of Inspector General (OIG) issued its 2013 Work Plan, setting forth the compliance and enforcement projects and priorities OIG intends to pursue in the coming year. The 2013 Work Plan contains 62 new projects affecting providers, suppliers, and payors, as well as Part C, Part D, and Medicaid (in addition to 37 other new projects such as public health reviews and department-specific reviews). Compared to last year’s Work Plan, the 2013 Work Plan contains a noticeable increase in the number of new projects related to hospitals, DMEPOS suppliers, and reviews of Medicare Contractor operations. Notable new projects include the Medicare DRG payment window, provider-based status, billing for diabetes test strips, and an assessment of CMS’ oversight over the activities of the Medicare Administrative Contractors. Interested providers and suppliers can review the Work Plan or speak with their legal counsel about specific projects affecting their business.

At the beginning of each new fiscal year, the OIG issues its Work Plan, reflecting (in large part) only two aspects of the OIG’s work: projects originating within the Office of Audit Services (OAS), which conducts financial, billing, and performance audits of HHS programs; and projects originating within the Office of Evaluations and Inspections (OEI), which provides management reviews and evaluations of HHS program operations. Like many to-do lists, OIG's plan is aspirational and, as a result, many projects are carried over from year-to-year as priorities shift and projects planned in the beginning of the fiscal year are set aside.

Overall, the Work Plan continues a focus on the changes introduced by the Patient Protection and Affordable Care Act (PPACA). Compared to last year’s Work Plan, the 2013 Work Plan contains a noticeable increase in the number of new projects related to hospitals, DMEPOS suppliers, and reviews of Medicare Contractor operations. Notable new projects include the Medicare DRG payment window, provider-based status, billing for diabetes test strips, and an assessment of CMS’ oversight over the activities of the Medicare Administrative Contractors. As can be expected, these new projects and the overall direction of the 2013 Work Plan is influenced by the changing areas of fraud and abuse focus and resource allocation under federal health care programs.

Providers and suppliers relying on the Work Plan to influence their own compliance agendas for the upcoming year should speak with their legal counsel or review the Work Plan in full, and also are reminded that the Work Plan is not an all-inclusive listing of OIG's areas of interest.

OIG has announced a long set of priorities in its plan for audits and evaluations in this third year of post-health care reform. With the size and scope of these various projects, we can anticipate OIG will be required to balance priorities and assess which projects will be most important. Ultimately, health care providers, suppliers, facilities, and payors are advised to keep in mind the OIG projects related to their line of business, as it can help shed light on those areas of compliance the OIG believes important.

Access a copy of the complete OIG 2013 Work Plan here.