Integrity and the Office of Inspector General, Essay Example

The Office of Inspector General (OIG) has many responsibilities.  It helps to protect the integrity of the Department of Health & Human Services (HHS) and other programs related to the health and welfare of citizens of the United States.  According to its website, the OIG is the “largest inspector general’s office in the Federal Government,” and helps to fight fraud, waste, abuse which may occur in HHS programs, such as Medicare and Medicaid.  The OIG plays an important role in the ethics of healthcare by regulating healthcare coding in addition to preventing fraud and abuse.

The OIG helps to educate the public about any potential fraud and abuse in the healthcare industry.  Patients are spared from unnecessary or incorrect procedures and taxpayers are not penalized for the dishonesty of certain healthcare providers and their staff.The OIG is composed of six units which audit, investigate, and evaluate HHS programs. These units include the Office of Audit Services, Office of Evaluation and Inspections, Office of Management and Policy, Offices of Investigations, and the Office of Counsel to the Inspector General. Healthcare programs such as Medicare and Medicaid are proactive in combating fraud and abuse.

Fraud and abuse often occur in relation to coding and documentation in the healthcare industry.  Hospitals, clinics, and physicians may use improper coding to overcharge for procedures and services which were not, or for supplies which were not provided.  Physicians may also bill for or provide procedures which are considered “unnecessary” by HSS and the OIG.

Coding errors often occur when healthcare providers and their staff engage in overcoding and undercoding. Overcoding occurs when physicians document and bill for extra services which were not performed. Undercoding occurs when physicians do not document and bill for all of the services performed, though this may be unintentional and the physician may be simply trying to help the patient financially. However, this is still misrepresentation, and the OIG must take measures to ensure that neither of these scenarios occur.

Fraud is intentional and abuse may be unintentional, yet distinguishing between the two can be difficult.  Sometimes errors in coding occur simply due to a mistake and lack of education.  The OIG helps to educate physicians and health care facilities to eliminate these errors and helps to save the tax payers a great amount of money.  Fraud and abuse are estimated “to account for between 3 to 15 percent of annual expenditures for healthcare in the United States” (Rudman , Eberhardt , Pierce & Hart-Hester, 2009).  Other forms of fraud and abuse in the healthcare industry may occur in the form of false-claims, kickbacks, and self-referrals.  The OIG and HSS help to fight these crimes on an administrative level and organize policies and procedures to penalize offenders and prevent potential healthcare provider and their staff from committing these offenses.  In 2007, HHS and OIG used $248 million to fight against fraud and abuse in healthcare and this resulted in an increase in the number of cases prosecuted, amount of money recovered, and the dollar amount of claims filed (Rudman , Eberhardt , Pierce & Hart-Hester, 2009).

While fraud and abuse continue to be prevalent in the healthcare industry, the OIG and HSS work hard to ensure that these occurrences happen as little as possible. Audits, investigations, and evaluations performed by the OIG help to keep the healthcare system more honest, and educate practitioners and their administrative staff about the correct way to assemble accurate medical records.  By enforcing accurate health care coding and documentation, and focusing on the prevention and penalization of fraud and abuse, the OIG can prevent both intentional and unintentional errors from occurring in the healthcare system.

References

Kalb, P. (1999). Health care fraud and abuse. JAMA, 282(12), 1163-1168. doi: 10.1001/jama.282.12.1163

Office of Inspector General: U.S. Department of Health and Human Services. (n.d.). About us. Retrieved from http://oig.hhs.gov/about-oig/about-us/index.asp

Rudman , W., Eberhardt , J., Pierce, W., & Hart-Hester, S. (2009). Healthcare fraud and abuse.

Perspectives in Health Information Management, 6, Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804462/