2025 OIG Audit Targets

Healthcare is a multi-trillion-dollar industry that remains highly regulated. When organizations bill for healthcare services, reimbursement is provided on a good-faith basis, with the expectation that clinical documentation accurately supports the services reported and that regulatory compliance is fully met. Each year, the Office of Inspector General (OIG) releases a work plan that highlights areas and services prioritized for audits in the upcoming fiscal year. This work plan is updated monthly, reflecting the most current high-risk areas.

To ensure compliance and avoid potential issues, it is crucial for organizations to remain vigilant and informed about these ongoing compliance initiatives. Proactively conducting regular audits of processes and clinical documentation is essential. Additionally, organizations must adhere to the mandatory self-reporting requirements established by the Affordable Care Act, which further reinforces the importance of maintaining compliance throughout all aspects of billing and documentation.

In this webinar, industry expert Toni Elhoms, CCS, CRC, CPC, AHIMA-Approved ICD10-CM/PCS Trainer, will cover essential aspects of healthcare compliance for 2025. The session will delve into the key governing authorities shaping healthcare regulations, explore the pathways involved in audits and investigations, and provide an in-depth review of the OIG work plan, including the most recent updates. Additionally, the webinar will spotlight current audit trends and targets for 2025, outline relevant action protocols, and share examples of the latest OIG advisory opinions. Participants will also learn about the critical elements of an effective compliance plan, based on the latest updates, and gain actionable best practice tips to ensure success in 2025 and beyond.

Webinar Objectives

This webinar aims to empower healthcare professionals with an in-depth understanding of the evolving compliance requirements for 2025. Participants will gain insights into the latest Office of Inspector General (OIG) Work Plan updates, key audit trends, and the regulatory expectations that impact billing, documentation, and overall compliance strategies. Through expert guidance, attendees will learn how to navigate complex audit processes, implement robust compliance plans, and proactively address potential risks.

The session will also provide practical tools and best practices for maintaining compliance with governing authorities, ensuring that organizations can mitigate audit exposure, avoid penalties, and achieve operational excellence in a highly regulated healthcare environment.

Webinar Agenda

• Understand the governing authorities involved in overseeing and enforcing healthcare compliance in 2025
• Recall the role of the OIG Work Plan
• Recognize 2025 trends and OIG audit targets in healthcare compliance
• Recall overpayment and voluntary refund protocols in 2025
• Recognize when the OIG self-disclosure protocol may be appropriate
• Understand recent OIG Advisory Opinions

Webinar Highlights

• Outline the governing authorities involved in overseeing and enforcing healthcare compliance in 2025
• Review the various pathways involved in healthcare compliance audit and investigations in 2025
• Discuss the role of the OIG Work Plan in 2025
• Deconstruct 2025 trends and OIG audit targets in healthcare compliance
• Discuss fee-for-service audit targets in 2025
• Review risk-adjustment audit targets in 2025
• Define the process of audit error rate extrapolation in 2025
• Identify key elements of an effective compliance plan based on the OIG framework in 2025
• Review the overpayment and voluntary refund protocols for 2025
• Discuss when the OIG self-disclosure protocol may be appropriate
• Review relevant and recent OIG Advisory Opinions
• Discuss proactive compliance best practice tips for 2025

Who Should Attend

• Medical Coding Specialists
• Medical Billing Specialists
• Medical Auditing Specialists
• Private Practice Physicians
• Managed Care Professionals
• Operations Leadership
• Practice Administrators
• Office Managers
• Compliance Officers/Committees  
• Chief Medical Officer