OIG Changes Focus Mid-year

Is your facility or physician practice in its sights?

The Office of Inspector General (OIG) released a mid-year update to its 2016 Work Plan. It includes several new reviews the OIG plans to begin in the near future, and just as many revisions to ongoing reviews, in nearly every sector. The agency tasked with detecting Medicare fraud, waste, and abuse also lists reviews it has completed or removed since releasing the initial 2016 Work Plan.

New for Medicare Parts A and B

The OIG will initiate the following new reviews:

  • Outpatient Outlier Payments for Short-Stay Claims
  • Intensity-Modulated Radiation Therapy (IMRT)
  • 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

Revised Ongoing Reviews:

  • Medicare Oversight of Provider-Based Status
  • Analysis of Salaries Included in Hospital Cost Reports
  • Home Health Prospective Payment System Requirements
  • Histocompatiblity Laboratories – Supplier Compliance with Payment Requirements
  • Covered Uses for Medicare Part B Drugs
  • Inpatient Rehabilitation Facility Payment System Requirements

Completed Reviews:

  • Medicare Did Not Pay Select Inpatient Claims for Bone Marrow and Stem Cell Transplant Procedures in Accordance with Medicare Requirements. Issued February 2016.
  • Hospices Inappropriately Billed Medicare Over $250 Million for General Inpatient Care. Issued March 2016.
  • CMS Has Not Performed Required Closeouts of Contracts Worth Billions. Issued December 2015.
  • National Background Check Program for Long-Term Care Employees: Interim Report. Issued January 2016.
  • Enhanced Enrollment Screening Process for Medicare Providers: Early Implementation Results. Issued April 2016.
  • Part B Payments for 340B Purchased Drugs. Issued November 2015.

Removed Reviews:

  • Imaging Services – Payments for Practice Expenses
  • End-Stage Renal Disease Facilities – Payment System for Renal Dialysis Services and Drugs
  • Contract Management at the Centers for Medicare & Medicaid Services

Review the entire mid-year updated work plan for details on these and other Medicare Parts A and B issues.

Renee Dustman
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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

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