Tuesday, December 15, 2015

OIG Releases FY 2016 Work Plan

Dianne De La Mare


The US Department of Health and Human Services, Office of Inspector General (OIG) has released its 2016 Work Plan, which describes new and on-going audits, evaluations and investigations. Key areas especially relevant for long term care (LTC) and post-acute care (PAC) providers include the following:

1. Under Medicare Part A and Part B there are explanations of OIG activities under the categories of Nursing Homes, Hospices, Home Health Services and Contractors:

a. National Background Check Program for LTC Employees

b. New Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Requirements

c. Revised Hospice General Inpatient Care

d. Home Health Services

e. Revised Medicare Benefit Integrity Contractors’ Activities in 2012 and 2013

f. Collection of Zone Program Integrity Contractor (ZPIC) and Program Safeguard Contractor (PSC) – Identified Medicare Overpayments

2. Under Medicare Part C and Part D there are explanations of OIG activities under Medicare Advantage (MA) and Prescription Drug Program:

a. MA Organizations’ Compliance with Part C Requirements

b. Part D Billing and Payments

3. Under Medicaid Program there are explanations of OIG activities under the categories of Home Health Services and Other Community-Based Care, Other Medicaid Services and Controls to prevent Improper Medicaid Payments and Medicaid Managed Care:

a. Room-And-Board Costs Associated with Home- and Community-Based Service (HCBS) Waiver Program Payments

b. State Use of Provider Taxes to Generate Federal Funding

c. State Cost Allocations That Deviate From Acceptable Practices

d. Enhanced Federal Medical Assistance Percentage

e. State Use of Incorrect Federal Medical Assistance Percentage (FMAP) for Federal Share Adjustments

f. Revised State and CMS Oversight of Provider Ownership Information

g. Revised Provider Payment Suspensions During Pending Investigations of Credible Fraud Allegations

h. Oversight of State Medicaid Fraud Control Units

i. State Payments to Managed Care Entities

j. Medicaid Managed Care Entities’ Identification of Fraud and Abuse

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