2026 HHS-OIG Work Plan Updates

2026 HHS-OIG Work Plan Updates

•  The OIG uses a dynamic, continuously updated work plan to respond to emerging risks in Medicare, Medicaid, and public health programs.

• Projects include audits, evaluations, and inspections across federal healthcare programs.

Key 2026 Healthcare‑Related Focus Areas

(Synthesized from the 2026 federal OIG Work Plan framework and the FY2026 OIG Annual Work Plan publication)

1. Medicare & Medicaid Program Integrity

• Increased audits targeting fraud, waste, and abuse in federal healthcare programs.

• Emphasis on high‑risk billing patterns, improper payments, and provider compliance.

2. Telehealth & Virtual Care Oversight

• Continued scrutiny of telehealth services following pandemic‑era expansion.

• Focus on:

• Eligibility compliance

• Documentation sufficiency

• Duplicate or excessive billing

• Cross‑state licensure issues

3. Managed Care (Medicare Advantage & Medicaid MCOs)

• Reviews of:

• Risk‑adjustment data accuracy

• Prior authorization practices

• Denial patterns

• Network adequacy

4. Pharmacy & Prescription Drug Oversight Audits of:

• 340B program compliance

• Drug pricing and rebate accuracy

• Controlled substance prescribing patterns

5. Hospitals & Outpatient Departments Focus on:

• Emergency department billing

• Outpatient facility E/M coding

• Device credits and implantable device billing

• Cost report accuracy

6. Home Health, Hospice, and Post‑Acute Care Reviews of:

• Eligibility and recertification

• Visit documentation

• Hospice levels of care

• Home health plan‑of‑care compliance

7. Behavioral Health & Substance Use Treatment

• Oversight of:

• Opioid treatment programs

• Tele‑behavioral health

• Medicaid behavioral health provider enrollment and billing

8. IT Security & Cybersecurity in Healthcare

• Evaluations of:

• Electronic health record (EHR) security

• Data‑sharing safeguards

• HIPAA‑related vulnerabilities