OIG Physician Roadmap

On , in Documents, by AQ-IQ LLC

OIG Provides Physician Roadmap

According to the OIG’s website, “Most physicians strive to work ethically, render high-quality medical care to their patients, and submit proper claims for payment. Society places enormous trust in physicians, and rightly so. Trust is at the core of the physician-patient relationship. When our health is at its most vulnerable, we rely on physicians to use their expert medical training to put us on the road to a healthy recovery.”

The Federal Government also places enormous trust in physicians. Medicare, Medicaid, and other Federal health care programs rely on physicians’ medical judgment to treat beneficiaries with appropriate services. When reimbursing physicians and hospitals for services provided to program beneficiaries, the Federal Government relies on physicians to submit accurate and truthful claims information.

The presence of some dishonest health care providers who exploit the health care system for illegal personal gain has created the need for laws that combat fraud and abuse and ensure appropriate quality medical care. This brochure assists physicians in understanding how to comply with these Federal laws by identifying “red flags” that could lead to potential liability in law enforcement and administrative actions. The information is organized around three types of relationships that physicians frequently encounter in their careers:

  1. Relationships with payers,
  2. Relationships with fellow physicians and other providers, and
  3. Relationships with vendors.

The key issues addressed in this brochure are relevant to all physiscians, regardless of
specialty or practice setting.

Click here for the OIG Booklet

OIG developed a document that summarizes the five main Federal fraud and abuse laws and provides tips on how physicians should comply with these laws. Click Here to View


OIG has provided training materials for Physician Education. Click here for the web page with multiple training options. Click Here for the portion related to relationships with vendors

CMS offers this course via their Learning Management System with Continuing Education Credit

A revised Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians Web-Based Training (WBT) course is available through the Medicare Learning Network Learning Management System. Learn about:

  • Laws governing health care fraud and abuse
  • Real fraud and abuse cases
  • Medicare fraud and abuse resources

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