Reduce the Risk, Cost & Aggravation of an OIG Audit
The Office of Inspector General (OIG) is actively auditing Medicare Advantage plans. These audits may have significant implications for plans, potentially resulting in substantial repayments, reputational damage, and non-compliance penalties.
The OIG is reviewing data submitted by health plans and selecting plans with a high likelihood of incorrect codes based on the OIG’s criteria. So far, plans selected for audit have a less than 10% rate of successfully defending reviewed cases.
Learn more about how you can protect your plan’s financial health, reputation, and market position. Our risk adjustment experts can help establish preventive controls and monitoring to mitigate risk and optimize your plan’s performance.
Quantify Your OIG RA Audit Target Risk
ATTAC applies analytics to your plan data that replicates the OIG’s targeting algorithms and can provide precise information and insight on:
- Your plan’s exposure in terms of members, cases and payments
- Members and dates of service that might be in an OIG suspect universe to allow your plan to investigate and take action
- Analytics support reviews from 2016-2023 and 2024’s Medicare Advantage risk adjustment model
Take Action on OIG RA Targets & Issues
ATTAC can assist your plan to take action to resolve issues, conditions and HCCs targeted by the OIG. We:
- Conduct full mock OIG risk adjustment audits, including identifying problem cases and submitted HCCs
- Assist plans develop strategies and procedures to address high-risk cases
- Test your vendor’s targeting accuracy
- Provide ongoing OIG targeted risk adjustment data analytic services to identify and review cases on a routine basis
ATTAC Provides Assistance to Risk-bearing Provider Groups for OIG Risk Adjustment Audit Issues
Provider groups that have contracted for percentage of premium and other risk-bearing payment arrangements are likely to be impacted by OIG risk adjustment audits. ATTAC provides support for provider entities to:
- Quantify the group’s exposure across all its contracted Medicare Advantage plans
- Review contact provisions that may result in MA plans recouping payments from previous years
- Implement internal strategies to mitigate submission of potentially problematic diagnoses in the future
