How the OIG Contractor Audits Relates to CMS

You’ve probably heard of the Office of Inspector General (OIG). You might have even read some of their reports, but do you know the OIG’s purpose and how it relates to the Centers for Medicare & Medicaid (CMS)? This article will provide you with more information about the OIG and help you understand its value to the industry. 

OIG History 

The OIG leads the United States’s fight against Medicare and Medicaid waste, fraud, and abuse along with more than 100 other Department of Health & Human Services (HHS) programs. The HHS OIG has the largest inspector general’s office in the Federal Government, with around 1,600 staff members.

Why Medicare and Medicaid?

The Medicare and Medicaid programs represent a large portion of the federal budget and directly impact the country’s vulnerable men and women. 

Office of Audit Services (OAS)

The OAS conducts independent audits into the Medicare and Medicaid programs. 

Their audits:

  •   Assess the program and its operations
  •   Examine the program’s performance
  •   Search for waste, abuse, and mismanagement
  •   Promote efficiency throughout the program

Past Audits

The OIG’s past audits have helped to uncover Medicare and Medicare mistakes that led to waste.

Some of their past audits include:

OIG Strategic Plan for 2020-2025

The current OIG plan outlines its current priorities in the next few years and will guide them on where they should spend their time and resources. You can read the entire strategic plan here.

Some of their priorities regarding the Medicare and Medicaid programs include:

  •   Medicare Advantage 
  •   Emergency preparedness and response for Medicare beneficiaries
  •   Patient safety and accuracy of payment for in-home and community settings
  •   Proper spending of Medicare funds
    •   Payment accuracy
    •   Efficiency of payment polices
    •   Eligibility determinations

You can read more details on page 18 in the report here

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