Will Ohio KePRO refer an individual case to the Office of the Inspector General (OIG) or will it look for patterns before it makes referrals?
Ohio KePRO contractually must refer an individual case to the OIG if there is a reason to believe there is intent to defraud on the part of the provider. Ohio KePRO anticipates that referrals of individual cases will be rare. Under HPMP, single cases may well trigger a wider examination to determine whether a payment error exists. If a pattern is detected, education would typically be the first remedy Ohio KePRO employs. Ohio KePRO would refer a pattern of payment errors to the OIG only when educational efforts have failed or if the provider failed to comply with any obligation in a substantial number of admissions, or grossly and flagrantly violated any obligation in one or more instances.
Related Questions
- Will Ohio KePRO refer an individual case to the Office of the Inspector General (OIG) or will it look for patterns before it makes referrals?
- What is the Office of Inspector General’s (OIG) annual workplan and where is it located?
- What kind of investigations does the Office of Inspector General (OIG) conduct?
