The 2011 OIG Work Plan

Every fall, the Office of Inspector General publishes a work plan for the coming year. It contains project areas believed to be “vulnerabilities” of the Department of Health and Human Services programs. The 2011 work plan, published October 1, 2010, contains items specific to ophthalmology as well as other areas pertinent to ophthalmic practice. They include:

• Place of Service Errors
• E/M Services During Global Surgery Periods
• E/M Services
• Compliance with assignment rules
• Modifiers GA / GZ / GY and appropriate use
• Error-Prone Providers
• Durable Medical Equipment Claims submitted with modifiers
• Average sales price to Average manufacturer price for drugs
• Cost / Payments for Lucentis and Avastin
• Usage / Payments for Lucentis and Avastin

Italicized issues are new to the OIG plan; other items have appeared before and continue to be scrutinized.

Additional topics exist in the plan. The above topics were called out because of their applicability to ophthalmologists and optometrists. We encourage you to review the full report at: http://www.oig.hhs.gov/publications/workplan/2011/