OIG Mid-Year Work Plan Update

Brett Seekins, Healthcare Consulting Senior Manager
June 2015

The U.S. Department of Health and Human Services Office of Inspector General recently issued its mid-year Work Plan update (May 2015). This release summarizes the FY 2015 OIG activities and reviews related to Health and Human Service programs.

The OIG is charged with monitoring and protecting the integrity of HHS programs. As such, a work plan is released annually, subject to mid-year updates, which identifies areas of concentration and risk that the Office will be testing, monitoring and analyzing. This mission serves over 100 programs administered by HHS at agencies such as the Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention. 76% of the Office’s funding is dedicated toward monitoring the effective and efficient use of resources that pay for Medicare and Medicaid services. In 2014, over $4.9 billion dollars were reported as expected audit recoveries for over-billed or fraudulent claims.

It is clear through reading the mid-year work plan that the OIG will continue to review at risk payments as well as scrutinize the following issues:

Hospitals

  • Reconciliation of outlier payments
  • Use of O/P and I/P stays under the 2-midnight rule
  • Cost associated with defective medical devices
  • Analysis of salaries reported on Medicare cost reports
  • Wage Index

Nursing Homes

  • Part A Billing
  • State agency verification of deficiencies
  • National background checks for long term care employees

Hospice

  • General Inpatient Care

Home Health Services

  • Prospective payment system requirements
  • Employment of individuals with criminal convictions

Physician Services

  • Provider Based facility criteria examinations
  • Comparison of Provider Based and Freestanding clinics
  • Place of service coding errors

In addition to these major providers the OIG will also be reviewing MAC procedures, State operations and payment policies, Medical Equipment Suppliers, Medicare Part C and D programming, Prescription Drug payments and the 340B Program.

More information and the OIG 2015 Mid-Year Work Plan Update can be found here.