Which government area investigates possible cases of DRG creep?

• A. Department of Health and Human Services
• B. Department of Justice
• C. Centers for Medicare and Medicaid Services
• D. Office of Inspector General

Answer: (B)

The investigation of possible cases of Diagnosis-Related Group (DRG) creep falls primarily under the jurisdiction of the Office of Inspector General (OIG). The OIG is dedicated to protecting the integrity of programs that the Department of Health and Human Services (HHS) administers, particularly Medicare and Medicaid. They conduct investigations and audits to ensure compliance with healthcare regulations and to address fraud and abuse associated with coding and billing practices, including issues related to DRG creep, where hospitals may improperly upgrade the severity of cases to receive higher reimbursement rates.

The other choices, while important agencies within the healthcare system, have different primary functions. The Department of Health and Human Services oversees health-related policies but does not specifically focus on investigating DRG creep. The Department of Justice is involved in legal actions and prosecutions related to healthcare fraud but may not conduct the direct investigations into coding practices. The Centers for Medicare and Medicaid Services (CMS) administers the nation’s major healthcare programs but is not the primary investigative body for potential abuses associated with DRG assignments. Therefore, the Office of Inspector General is the most appropriate agency for this particular concern.