OIG Work Plan: HHS Office of Inspector General Audit Priorities
The OIG Work Plan is the HHS Office of Inspector General's published, regularly updated list of audits, evaluations, and enforcement projects targeting fraud, waste, and abuse in Medicare, Medicaid, and other HHS programs. For billers it signals which services, codes, and providers are under active federal scrutiny — a preview of where audits and recoupments are headed.
- Enforced by
- HHS Office of Inspector General
- Applies to
- Medicare, Medicaid, HHS program participants
- Penalty
- Signals audits; findings can lead to FCA/CMPs
What is the OIG Work Plan?
The OIG Work Plan is a living document from the HHS Office of Inspector General listing the specific audits and evaluations it is running or planning across federal health programs. OIG moved to a monthly-updated, searchable online format years ago, so items appear and drop off continuously. Each entry names the topic, the program, and the expected report timeframe.
Think of it as the federal government publishing its audit targets in advance. That transparency is a gift to any biller who reads it.
How do billers use the Work Plan?
Match Work Plan items to your revenue. If a current item covers, for example, telehealth place-of-service accuracy, hospice general inpatient level of care, or specific drug units under an MUE, and those codes are meaningful in your book, prioritize internal review there.
How does it fit a compliance program?
An effective compliance program uses risk assessment to decide where to audit; the Work Plan is a ready-made, authoritative source of risk areas. Pairing it with your own denial data and NCCI trends tells you where documentation and coding are weakest. It also connects to the 60-day overpayment rule: once a self-audit identifies overpayments, the clock to refund starts.
How do you turn a Work Plan item into action?
- Identify Work Plan items that overlap your specialty and high-volume codes.
- Pull a sample of matching claims and audit documentation against the rule.
- Correct coding and documentation gaps prospectively; retrain the responsible staff.
- If you find overpayments, quantify and refund within the 60-day window.
Persistent problems can escalate to the False Claims Act, so early self-correction is the point.
Frequently asked questions
It is the HHS Office of Inspector General's public roadmap of the audits and evaluations it plans to conduct across Medicare, Medicaid, and HHS programs. OIG updates it regularly (items are added and removed monthly), so it functions as an early-warning system: if a service or billing pattern appears, expect data mining, audits, and possible enforcement in that area.
CMS runs Medicare and Medicaid and sets payment and coverage policy. The OIG is the independent watchdog inside HHS that investigates fraud, waste, and abuse, conducts audits, issues advisory opinions, and can exclude providers from federal programs. A CMS contractor pays your claims; the OIG investigates whether they should have.
Yes. Cross-reference active Work Plan items against your own claim mix. If OIG is auditing, say, high-level E/M coding or a specific drug's units, and you bill a lot of it, that is where you should run internal audits and tighten documentation first. It lets you self-correct before an external audit finds the same thing.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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