OIG Update for Urology


The Office of the Inspector General (OIG), as the investigative and enforcement arm of the Department of Health and Human Service (HHS), released a work plan for the upcoming year.

Specific to practices, the OIG is continuing to focus on Medicare oversight of “provider­based status” with a revised ruling. According to the work plan, “We (OIG) will determine the number of provider­based facilities that hospitals own and the extent to which CMS has methods to oversee provider­based billing.” Provider­based status allows facilities owned and operated by hospitals to bill as hospital outpatient departments and can result in a higher Medicare payment, including the equipment utilization rate. Private practice urologists who own diagnostic imaging equipment need to “remain vigilant about documenting their reasons for ordering those tests and review their own utilization rates,” according to Dr. Robert Dowling, vice­president Medical Affairs and Policy, ION Solutions.

In addition, the OIG has removed language in its work plans for 2015 and 2016 around the scrutiny of evaluation and management services and possible inappropriate payments. The OIG also removed language around laboratory tests – billing characteristics and questionable billing – but retained language around annual analysis of Medicare clinical laboratory payments, adding referring/ordering Medicare services and supplies. The OIG also made changes to physicians and suppliers, removing language around noncompliance with assignment rules and excessive billing of beneficiaries, and place of service coding errors.

Dr. Dowling gives a full explanation of each of these revisions in a recent column published in Urology Times. To see the full article, click here.