New Work Plan Targets Provider-Based Status; OIG Roadmap Has Some Surprises

It looks like scrutiny of provider-based entities will escalate over the next two years because the HHS Office of Inspector General (OIG) is reviewing them from all angles, according to its new Work Plan for fiscal year 2009, released Oct. 1, the first day of the federal government’s fiscal year. OIG will assess whether inpatient and outpatient facilities and hospital-owned physician practices that bill Medicare under the provider-based designation comply with CMS requirements. Provider-based status generates more Medicare reimbursement, so noncompliance could lead to over-payments. Lawyers say they hope OIC will stick to substantive noncompliance, and not demand repayments based on a few mistakes, considering the many hoops hospitals jump through for provider-based status.

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