OIG’s New “Data Analysis Project”– Has OIG Released its own RAC/ZPIC?

stacks of books data analysis project

   Exclusion Screening, LLCSM keeps a close eye on the Department of Health and Human Services Office of the Inspector General’s (OIG) exclusion enforcement action.  Recently, we noticed alarming new language that describes how an exclusion violation came to the OIG’s attention. Specifically, the OIG stated that it identifies excluded individuals through “data analysis projects.”

I.  Data Analysis Projects: What Are They?

  Our health care compliance-minded staff generally associates “data analysis projects” with Recovery Audit Contractors (RACs) and Zone Program Integrity Contractors (ZPICs).  The Centers for Medicare and Medicaid contract with RACs and ZPICs to review and correct improper payments made by the Medicare program to health care providers and suppliers. RACs work on a contingency-fee basis, taking a percentage of the amount they “correct.”  There is no confirmation that the OIG has, in fact, contracted with auditors like RACs and ZPICs because the OIG has not released any guidance about these new “data analysis projects.”  While the OIG may or may not have hired contractors to help identify health care providers committing fraud, the existence of these projects indicates that the OIG has found another way to aggressively pursue excluded individuals who continue to participate in the Federal health care programs.  This means that the OIG is no longer waiting for providers to self disclose or wait for ZPICs or RACs to identify potential issues.  The OIG could now be searching out excluded providers on its own.

II.  New OIG Offices Taking on Exclusions 

  If this was not alarming enough, the two most recent OIG enforcement actions that arose from “data analysis projects” were from two  offices within the OIG that are not normally in charge of exclusion violations; specifically, the Office of Evaluation and Inspections (OEI) and the Office of Audit Services (OAS).

   The Office of Investigations (OI) is the office generally associated with investigating exclusion violations because it conducts criminal, civil, and administrative investigations of fraud and misconduct within the Federal health care programs.  However, it is strange for the OEI, whose mission is to conduct “national evaluations,” to identify a single Alabama hospital that employed one excluded individual. Additionally, while the OAS regularly conducts audits of the Federal health care programs, its audits are typically targeted at State compliance with Federal program requirements and usually focus on large overpayment or billing allegations.  The times are clearly changing, however, evidenced by OAS’s settlement with a 74-facility nursing home in Texas, which resolved allegations that the organization employed seven excluded individuals in seven separate offices.

III.  Key Takeaway: Exclusions Quickly Becoming a High Priority for OIG

Just these two “data analysis projects” alone resulted in CMPs totaling $469,311.07.  Not a small amount for two OIG offices that do not typically handle exclusion violations.  The new “data analysis projects” are obviously a success for OEI and OAS; this could potentially mean more and more of the OIG’s resources will be targeted toward enforcement actions relating to exclusion violations.   Providers should be on alert and must protect themselves by checking all potential and current employees, contractors, and vendors against all Federal and State exclusion lists monthly.  If complying with Federal and State exclusion screening requirements and conducting proper monthly screening is burdensome for your office, please contact Exclusion Screening, LLCSM for a free cost assessment at 1-800-294-0952 or fill out our service form.

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