Monday, November 17, 2014

OIG Releases 2015 Work Plan

Dianne De La Mare

The US Department of Health and Human Services (HHS), Office of Inspector General (OIG), has released its 2015 work Plan, which summarizes new and on-going OIG reviews, audits and other activities that the agency plans to pursue in FY 2015. OIG was created to protect the integrity of HHS programs and operations and the well-being of beneficiaries by detecting and preventing fraud, waste and abuse; identifying opportunities to improve program economy, efficiency and effectiveness; and holding accountable those who do not meet program requirements or who violate federal health care laws. The FY 2015 OIG Work Plan acts as a guide for AHCA/NCAL membership, identifying the specific areas where long term care and post-acute care providers can expect OIG focus and involvement. For skilled nursing facilities (SNFs), OIG plans to review the following areas:

· Medicare Part A billing by skilled nursing facilities – OIG will describe changes in SNF billing practices from FYs 2011-2013. Prior OIG work has found that SNFs increasingly billed for the highest level of therapy even though beneficiary characteristics remained largely unchanged. Expected issue date of this report is due in 2015.

· Questionable billing patterns for Part B services during nursing home stays – OIG will identify questionable billing patterns associated with SNFs and Medicare providers for Part B services provided to residents during stays not paid under Part A. For example, stays during which benefits are exhausted or the 3-day prior inpatient stay requirement is not met. Expected issue date of this report is due in 2015.

 · State agency verification of deficiency corrections – OIG will determine whether state survey agencies verified correction plans for deficiencies identified during nursing facility (NF recertification surveys. Prior OIG work has found that one state survey agency did not always verify that NFs corrected deficiencies identified during surveys in accordance with the federal requirements. Expected issue date of this report is due in 2015

· Program for national background checks for long-term-care employees – OIG will review the procedures implemented by participating states for long term care facilities or providers to conduct background checks on prospective employees and providers who would have direct access to patients and determine the costs of conducting such background checks. Expected date of this report is due in 2015.

 · Hospitalizations of nursing home residents for manageable and preventable conditions – OIG will determine the extent to which Medicare beneficiaries residing in NFs are hospitalized as a result of conditions thought to be manageable or preventable in the NF setting. Expected issue date of this report is due in 2015.

For assisted living facilities (ALFs), OIG has plans to review Hospices in ALFs settings. For home health (HH) services, OIG has plans to review Home health prospective payment system requirements and Employment of individuals with criminal convictions.

To obtain a copy of the full OIG Work Plan FY 2015 go to

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