Wednesday, June 3, 2015

OIG FY 2015 Work Plan Mid-Year Update

Dianne De La Mare

The US Department of Health and Human Services (HHS), Office of Inspector General (OIG) has released a report titled, Work Plan Mid-Year Update for Fiscal Year 2015, which summarizes new and ongoing reviews and activities that the agency plans to pursue in FY 2015 and beyond. The report describes the primary objectives, the internal identification code and the year in which it expects a report to be issued as a result of the OIG review. Activities specific to long term care and post-acute providers include:

· Medicare Part A and Part B – Nursing Homes: Medicare Part A billing by skilled nursing facilities (SNFs), state agency verification of deficiency corrections, and program for national background checks for long term care employees;

· Part A and Part B Contractors: Medicare benefit integrity contractors’ activities, and Zone Program Integrity Contractors (ZPICs) and Program Safeguard Contractors (PSCs) -- identification and collection status of Medicare overpayments;

· Medicare Part C and Part D: MA Organizations’ Compliance with Part C Requirements (use of Medicare Advantage (MA) encounter data -- CMS oversight of data integrity, and risk adjustment data -- sufficiency of documentation supporting diagnoses);

· Under Medicaid: State Management of Medicaid (how states fund their Medicaid programs, state claims for federal reimbursement, state adjustments of federal reimbursement, state program integrity activities and compliance with federal requirements, and OIG oversight of State Medicaid Fraud Control Units (MFCUs);

· Under Medicaid Managed Care: State payments to managed care entities, data collection and reporting, program integrity in managed care, and beneficiary protections in managed care.

To obtain the full OIG report go to

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