The United States Department of Health and Human Services, Office of Inspector General (OIG) continues to update its Work Plan monthly. As we previously noted, the OIG has gone from an annual update to monthly updates as a way to enhance transparency. It sets forth various projects including OIG audits and evaluations that are underway or planned to be addressed during the fiscal year and beyond.
The following are some highlights of actions taken during the first quarter of 2018.
OIG Toolkit to Identify Patients at Risk of Opioid Misuse: The OIG will focus on the creation of a toolkit to provide information on how it performed its analysis of a dataset of opioid claims to produce patient-level opioid data. Last year, the OIG found that 500,000 Medicare Part D beneficiaries received high amounts of opioids in the previous year. The OIG also found that nearly 90,000 of them were at serious risk of opioid misuse or overdose. The OIG plans to release a toolkit this year to help public and private stakeholders in addressing the opioid epidemic.
Potential Abuse and Neglect of Medicare Beneficiaries: Medicare beneficiaries, including elders and disabled persons, are being treated at inpatient and outpatient medical facilities for conditions that may be the result of abuse or neglect. Previous OIG reviews have found problems with the quality of care and the reporting and investigation of potential abuse or neglect at group homes, nursing homes, and skilled nursing facilities. By analyzing the treating medical facilities’ diagnoses, OIG will determine how prevalent the potential abuse or neglect of Medicare beneficiaries is and whether the potential abuse or neglect occurred at a medical facility or at another location, such as the beneficiary’s home.
Questionable Billing for Off-the-Shelf Orthotic Devices: A Medicare Administrative Contractor (MAC) identified high improper payments associated with claims for three off-the-shelf orthotic devices (L0648, L0650 and L1833). The MAC cited medical necessity as a top concern. The OIG plans to “evaluate the extent to which Medicare beneficiaries are being supplied these orthotic devices without an encounter with the referring physician within 12 months prior to their orthotic claim and will analyze billing trends on a nationwide scale.”
Review of Statistical Methods Within the Medicare Fee-For-Service Administrative Appeal Process: The OIG will review how the government is applying statistical methods during the Medicare fee-for-service administrative appeal process. Medicare program integrity contractors are authorized to use statistical sampling to determine how much a provider had been overpaid. OIG wants to know if Medicare Administrative Contractors (MAC) and Qualified Independent Contractors (QIC) are reviewing statistical estimates in an “appropriate and consistent manner.”
Data Brief: Opioid Use in Medicare Part D: Faced with an increasing number of overdose deaths from opioids, the OIG will create a data brief that will provide updated data on Part D spending for opioids and the number of beneficiaries who received extreme amounts of opioids through Part D and those who appear to be “doctor shopping.”
Healthcare providers should review these monthly updates and use them to update policies and procedures. If you have any questions or concerns, the Health Law Offices of Anthony C. Vitale can assist. Contact us for additional information at 305-358-4500, or send us an email to firstname.lastname@example.org and let’s discuss how we might be able to help.