OIG adds 21 new investigative focus areas

A blue door with two small holes in it.The Office of Inspector General at the U.S. Department of Health and Human Services recently released the midyear update  of its annual work plan, which not only outlined its accomplishments between October 2014 and May 2015 but also added 21 new focus areas for next year.

The OIG noted that it will continue to look at emerging payment, eligibility, management, and information technology systems security vulnerabilities in healthcare reform programs.

Among some of the more significant additions:

Hospital preparedness and response to high-risk infectious diseases

The OIG will describe hospitals’ efforts to prepare for the possibility of public health emergencies resulting from infectious diseases. It noted that previous OIG work found shortcomings in the areas of pandemic preparedness and hospital preparedness for a natural disaster, citing both Ebola and Hurricane Sandy as examples.

Access to durable medical equipment in competitive bidding areas

The OIG will determine whether the competitive bidding process for DMEPOS providers has led to reduced access for patients. It noted that under the Affordable Care Act,

Medicare’s payment system for certain DMEPOS was changed to a competitive bidding program from a fee schedule. “Anecdotal reports allege that competitive bidding has led to reduced access to DME and, in turn, compromised the quality of care beneficiaries receive,†the report noted.

Annual analysis of Medicare clinical laboratory payments

The OIG will conduct an analysis of Medicare’s clinical laboratory payments as part of an effort to adjust the payments based on rates paid by private insurers. Previous OIG work has found that Medicare pays more than other insurers for certain high-volume and high-expenditure laboratory tests.

Inpatient rehabilitation facility (IRF) payment system requirements

The agency will review compliance with various aspects of the IRF PPS, including documentation requirements in support of the claims paid by Medicare, to determine whether IRF claims were paid in accordance with federal laws and regulations.

Use of electronic health records to support care coordination through ACOs

The OIG will look at how those providers participating in ACOs in the Medicare Share Savings Program use electronic health records to exchange healthcare information to achieve their care coordination goals, as well as to identify best practices and possible challenges in their progression toward interoperability (i.e. the extent that information systems can exchange data and have the ability to interpret those shared data).

As seen below, a significant number of the new reports will be focusing on the pharmaceutical market which, in recent years, has seen an increase in the amount of fraud and abuse.

Part D oversight

This will include a review of previous OIG audits, evaluations, legal opinions and investigative work on Medicare Part D to be used to provide progress information on recommendations to improve oversight of the program by responsible agencies.

Billing trends for Part D drugs and commonly abused opioids

Because prescription drug diversion and abuse are growing problems, the OIG will look into the dispensing of the most commonly abused painkillers. “OIG is also seeing a significant increase in Part D fraud and has a wide portfolio of work involving pharmaceutical matters, including prescription drug diversion,†it noted in the report.

Manufacturer rebates – Federal share of rebates

The OIG said it will review states’ reporting of the federal share of Medicaid rebate collections to determine if they are correctly identifying and reporting the increases in rebate collections.

Analysis of generic price increases compared to price index

Currently, there is no inflation rebate provision for generic drugs as there is for brand-name drugs. The agency will analyze generic drug prices to determine whether they have increased more than inflation and will quantify potential savings from requiring an inflation-based rebate for generic drugs.

  • The remaining reports will look at a variety of other areas including:
  • Reimbursement for intensity-modulated radiation therapy (IMRT);
  • Drug manufacturers’ treatment of sales of authorized generics;
  • Determine whether states are submitting complete Transformed Medicaid Statistical Information System data;
  • Review the CDC’s process for awarding funding for Ebola preparedness and response activities to ensure compliance with applicable laws and regulations;
  • Review the FDA’s monitoring of imported food recalls to ensure the safety of the nation’s food supply, among others.

Healthcare providers can use the latest report to identify compliance risk areas and to better understand and prepare for the new developments by updating their compliance program activities, audits and policy development.

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The Health Law Offices of Anthony C. Vitale