Corporate Compliance

Don’t forget about Medicaid: 2009 OIG Work Plan highlights compliance concerns

Health Care Auditing Strategies, February 1, 2009

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The OIG focuses many of its planned Medicaid audits, reviews, and investigations on state agencies and their program operations. For example, the OIG will review state processes for enrolling Medicaid providers. According to the Work Plan:

States are required to collect information from providers regarding the ownership of healthcare entities and criminal convictions as part of the enrollment process for participating in federal healthcare programs. However, there is no corresponding requirement that states verify the information.

Just because many audits are state-focused doesn’t mean providers can breathe easy when it comes to -Medicaid compliance enforcement from government enforcers. Be aware that many items directed toward state agencies will have an effect on providers, says Sara Kay Wheeler, partner at King & Spalding in Atlanta. In other words, the OIG’s reviews of state agencies will likely result in those states agencies performing more reviews and audits on providers in that state, Wheeler says. “Some, but not all, of these efforts that are focused on states will have a trickle-down effect,” she says.

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