Audits and Oversight Top OIG’s Workplan List for January

The January update to the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) Workplan is out and there are several items that should be of interest to our clients.

The Workplan sets forth various projects that either are underway or will be addressed during the fiscal year and beyond by the OIG’s Office of Audit Services and Office of Evaluation and Inspections. Each month, the Workplan is updated.

DME-related Fraud

The first has to do with fraud, waste and abuse related to orthotic braces. It’s been an area of interest for investigators for a long time. As is often the case with DME-related fraud, orthotics are provided and billed to Medicare that were not medically necessary. For example, in 2019 Investigators broke up a $1.2 billion Medicare fraud in which doctors, telemarketers and owners of medical equipment companies sold medically unnecessary braces to hundreds of thousands of elderly and disabled people.

Last July, we wrote about a Coconut Creek man who was arrested and charged with submitting false claims for $5 million on behalf of Medicare beneficiaries who said they did not want or need orthotic braces and/or did not receive them.

OIG says it will put together the results of prior audits, evaluations and investigations of orthotic braces that were paid for by Medicare and analyze data to identify trends in payment, compliance and fraud vulnerabilities and then offer recommendations for improving ways to detect these vulnerabilities.

Telemedicine audits

With the huge increase in the use of telemedicine services resulting from the COVID-19 pandemic, the Centers for Medicare & Medicaid waived certain requirements in order to expand the provision of services to beneficiaries. For example, CMS waived certain requirements and amended regulations to allow home health agencies to use telecommunications systems in conjunction with in-person visits. The amended regulations state that: the use of technology must be related to the skilled services being furnished, and the use of technology must be included in the plan of care with a description of how the technology will help achieve goals without substituting for an in-person visit.

The OIG said it will take a look at those home health services provided by agencies during the public health emergency to determine which types of skilled services were furnished via telemedicine, and whether those services were administered and billed properly. OIG will report any services that were improperly billed and make appropriate recommendations to CMS based on the results of its review.

Medicare Part B Audits

Because of the important role that telemedicine has played during the pandemic, CMS has been looking at ways it can be expanded once the public health emergency is over to provide care to Medicare beneficiaries. Because of the changing role that telemedicine has played in the last year, OIG says it will conduct a series of audits of Medicare Part B telehealth services in two phases. Phase one audits will focus on making an early assessment of whether services such as evaluation and management, opioid use order, end-stage renal disease, and psychotherapy (Work Plan number W-00-21-35801) meet Medicare requirements. Phase two audits will include additional audits of Medicare Part B telehealth services related to distant and originating site locations, virtual check-in services, electronic visits, remote patient monitoring, use of telehealth technology, and annual wellness visits to determine whether Medicare requirements are met.

Home Health Audits

Home health agencies also have faced extraordinary challenges in providing care during the pandemic. Those challenges have included: obtaining necessary equipment and supplies, implementing telehealth to treat patients remotely, and dealing with staffing shortages.

While home health agencies have had to come up with ways to handle these challenges, it’s unknown which have worked and which have not.

OIG says it will conduct a nationwide study to provide insights into how home health agencies have addressed these challenges presented by the pandemic, including how well their emergency preparedness plans worked.

The Health Law Offices of Anthony C. Vitale has extensive experience representing clients in audits and overpayments and we can represent your interests through all of the stages of the overpayment appeals process.  If you have any questions or concerns, feel free to contact us at 305-358-4500 or info@vitalehealthlaw.com