OIG Attacks Ophthalmologists with Investigative Subpoenas

Friday, February 6, 2015
It's no secret that the Office of Inspector General (OIG) is stepping up enforcement lately.  But the newest focus of those efforts may surprise you: ophthalmologists.

Recently, we have seen an increase in the amounts of audits and subpoenas directed to ophthalmologists.   Zone Program Integrity Contractors (ZPIC) auditors (those are the fraud-focused ones) have been showing up in practices demanding access to records and employees more than before.

For a checklist on what do to when notified of a ZPIC or Medicare audit, click for for part one, and click here for part two.
Areas of Particular Focus.

We are also seeing an increase is the use of the U.S. Department of Health and Human Services (HHS), OIG issuing subpoenas for records, contracts, personnel files, leases, etc.  Ophthalmologists who see patients in nursing homes, assisted living facilities, or other long term care centers are especially susceptible to these actions.

It is crucially important when seeing patients in a facility other than your office, you make sure to document the medical necessity of the "house call."

Codes That Might Trigger an Audit or Subpoena.

The other major areas of concern we have seen relate to the frequency of the visits and the level of the code billed.  As always, the key to avoid issues in audits and investigations is documentation, documentation, and more documentation.  If your record supports the claim (even arguably so) the investigators typically lose interest very quickly.

Don't Go It Alone.

Unfortunately, there is more fraud going on than can be pursued so don't make yourself into low hanging fruit.

If you do find yourself the subject of an audit or subpoena, you should contact a professional experienced in managing those types of situations immediately.  Often a subpoena for records will only give a very limited amount of time in which to produce records.  Having an experienced health care attorney on your side can slow the process down and buy time to ensure that the proper records are produced.


Have you ever received notification of a ZPIC audit or subpoena? What was the experience like? Please leave any thoughtful comments below.

Don't Wait Until It's Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.
The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

About the Author: Lance O. Leider is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone:  (407) 331-6620.

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The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.
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Lance O. Leider, J.D., The Health Law Firm 2/6/2015

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