What Medical Billers and Coders Need to Know About the OIG

By Karen Smiley

The Office of Inspector General (OIG) was established in 1976 to oversee programs administered through HHS. Much of the OIG’s efforts focus on identifying waste, fraud, and abuse in Medicare, Medicaid, and other federal programs like Indian Health Services.

The OIG conducts audits and tracks how government funds are spent. The findings of these investigations are often the foundation for Medicare or Medicaid policy changes and procedural code changes initiated by CMS or the AMA. The OIG publishes the results of its investigation on its website.

Even though most of these government organizations are sole entities, they typically rely on each other in one way or another. For example, because developments in medical technology and treatment options are usually far ahead of legislation, Medicare often discovers through an OIG investigation that taxpayer funds are not being used efficiently.