OIG 2016 Work Plan Update What’s New?

This OIG 2016 Work Plan Update mid-year summarizes new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs and operations during the current fiscal year and beyond. Specifically, this edition of the OIG 2016 Work Plan removes items that have been completed, postponed, or canceled, and includes new items that have been started since October 2015.  Here is a summary of the OIG 2016 Work Plan Update showing how the Work Plan has changed since it was last updated in October 2015.

OIG 2016 Work Plan: Medicare Parts A and B

Medicare Part A covers certain inpatient services in hospitals and skilled nursing facilities (SNFs) and some home health services. Medicare Part B covers designated practitioners’ services; outpatient care; and certain other medical services, equipment, supplies, and drugs that Part A does not cover.

The OIG 2016 Work Plan has focused its Medicare oversight efforts on identifying and offering recommendations to reduce improper payments, prevent and deter fraud, and foster economical payment policies (OIG.HHS.gov) .

What’s New?

  • Outpatient Outlier Payments for Short-Stay Claims
  • Skilled Nursing Facility Prospective Payment System Requirements
  • National Background Checks for Long-Term-Care Employees
  • Potentially Avoidable Hospitalizations of Medicare and Medicaid Eligible Nursing Home Residents for Urinary Tract Infections
  • Accountable Care Organizations: Beneficiary Assignment and Shared Savings Payments
  • Medicare Home Health Fraud Indicators
  • CMS’ Implementation of New Medicare Payment System for Clinical Diagnostic Laboratory Tests
  • Intensity-Modulated Radiation Therapy

OIG 2016 Work Plan: Medicare Parts C and D

Medicare Part C offers Medicare beneficiaries a managed care option through Medicare Advantage (MA) plans, which are administered by MA organizations. MA plans are public or private organizations licensed by States as risk-bearing entities under contract with CMS to provide covered services. Medicare Part D, also called the Medicare prescription drug benefit, is a Federal program to subsidize the costs of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries. CMS and drug plan sponsors share responsibility for protecting the Part D program from fraud, waste, and abuse. Payments to drug plan sponsors, made on the basis of bids, risk adjustments, and reconciliations, add to the complexities and challenges of the benefit. HHS faces numerous challenges in managing its Part D program, including oversight, drug abuse and diversion, and questionable and inappropriate utilization (OIG.HHS.gov).

What’s New?

  • Increase in Prices for Brand-Name Drugs under Part D
  • Generic Drug Price Increases in Medicare Part D
  • Part D Data Brief Update

OIG 2016 Work Plan: Medicaid

The Federal Government and States jointly fund Medicaid, which provides medical assistance to certain low income individuals and individuals with disabilities. The OIG 2016 Work Plan include expectations to examine beneficiary access to, and program integrity of, mental and behavioral health services. In addition, the OIG plans to expand its examination of the quality and safety of care provided in a variety of home and community-based settings, including Medicaid personal care services (OIG.HHS.gov).

What’s New?

  • Physician-Administered Drugs for Dual Eligible Enrollees
  • Oversight and Effectiveness of Medicaid Waivers
  • State Medicaid Fraud Control Unit FY 15 Annual Report
  • States’ Compliance with Requirements for Treatment of Health-Care Related Taxes on Medicaid Managed Care Organizations
  • State Medicaid Agency Breach Protections and Responses

It can seem like a real slog to go though the entire OIG 2016 Work Plan Update to find the nuggets that apply to your organization.  Fortunately, the OIG is presenting this update in a series of slides (OIG 2016 Work Plan Slides), so you can find the investigations that apply to your type of organization relatively easily.  In any case, it is worthwhile reviewing to see if there are things coming up that should be on your own compliance annual work plan agenda for 2017!  It is essential to include the OIG 2016 Work Plan Update items in your compliance to do list.

When you need proven expertise and performance

Cindy Winn, MBA, CHSP

Ms. Cindy Winn has over 20 years of healthcare experience and expertise in operations, project management, and is certified as a HIPAA Security Professional (CHSP).

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