Corporate Compliance

OIG highlights biggest compliance challenges for 2009

Healthcare Auditing Weekly, January 13, 2009

Quality of care, Medicaid and the State Children’s Health Insurance Program (SCHIP), as well as Medicare integrity are among the most significant management and performance challenges facing the Department of Health and Human Services (HHS).
 
According to a report released by the OIG earlier this month, fraud, waste, and abuse schemes constantly adapt to the latest federal oversight efforts and technology, resulting in perpetual efforts to fight these crimes. Payment errors also add up quickly, causing billions in losses to the Medicare Trust Fund and taxpayers.
 
The vulnerability of the Medicaid and SCHIP population makes fighting fraud and abuse critical, the report stated. In 2007, SCHIP assisted about 7.5 million low-income children, with a federal cost of $6 billion.
 
As far as quality of care issues go, the OIG identified vulnerabilities in nursing homes, emergency services in hospitals, the operations of Quality Improvement Organizations (QIO), hospice oversight, and the ability of physician-owned specialty hospitals to manage medical emergencies.

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