The U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) published the 2016 edition of its annual Work Plan on Monday, Nov. 2. The plan describes new and ongoing initiatives of the OIG for the fiscal year 2016.
The OIG is responsible for detecting and preventing fraud, waste and abuse. In fiscal year 2015, the OIG is expecting to recover more than $3 billion as a result of its audits and investigations.
In recent years the OIG has conducted investigations of both sleep testing and delivery of positive airway pressure (PAP) therapy. The OIG 2016 Work Plan includes two investigations related to sleep medicine:
- Increased Billing for Ventilators – A new investigation by the OIG will consider billing for ventilators, respiratory assist devices (RAD) and continuous positive airway pressure (CPAP) devices delivered from 2011-2014. The investigation will address concerns, sparked by an increase in billing for ventilators, that ventilators may be prescribed when RAD or CPAP is more appropriate. The OIG expects to issue a report on this investigation in fiscal year 2016.
- Sleep Disorder Clinics – High Use of Sleep-Testing Procedures – This investigation is continuing from last year. The OIG is investigating the appropriateness of payments for sleep testing procedures due to concerns about the high utilization of procedure codes 95810 and 95811.
The AASM will update members as soon as reports on the two sleep-related investigations are released by the OIG.