Deeper Than the Headlines: 2017 HHS OIG Work Plan Highlights

Each year, the HHS OIG publishes a work plan which highlights areas they will focus their auditing and investigative resources upon. Some of the projects are continuations from the prior year’s work plan while some are new or revised. Many compliance programs use this document in their own annual work plans and internal compliance efforts.

The 2017 Work Plan was just released last week and you can view it here.

There are too many new projects announced in the work plan to detail in this short blog post, so I’m going to just highlight a few of the more interesting announcements. 

Hospitals

For hospitals, there were four new projects and one revision announced. Here are just a few:

• (New) Reimbursement for HBO Services ( we’re not talking about the cable channel). HBO is hyperbaric oxygen therapy often used in wound care. Patients are placed in a pressurized chamber where the oxygen pressure is significantly increased. The OIG is going to review whether Medicare outpatient reimbursement made to hospitals was consistent with the requirements of the National Coverage Determination Manual, Chapter 20.
• (New) Inpatient Psychiatric Facility Outlier Payments. OIG is concerned that the number of claims receiving outlier payments from these types of facilities saw a 28% increase. OIG intends to determine if those outlier payments were appropriate.
• (Revision) IMRT (Intensity-Modulated Radiation Therapy). IMRT is a precise and rather complex form of radiation treatment and is often completed in two phases; a planning phase and a delivery phase. Certain services should not be billed separately when they are performed during the forming of an IMRT plan. OIG will review these services in the outpatient setting.

Nursing Homes

For nursing homes, there were also four new projects and one revision announced. A couple of these include:

• (New) Reimbursement for Skilled Nursing Facilities (SNFs). SNFs are required to periodically assess patients using a tool called the Minimum Data Set (MDS) which contributes to the assignment of the Resource Utilization Group, or RUG, from which payment is made. OIG will review documentation to determine if the payment was accurate for the documented services.
• (New) OIG will assess the incidence of abuse and neglect of Medicare beneficiaries in SNFs and determine if the instances were correctly reported and investigated.

Hospice

The OIG announced three new projects in hospice services. One of the most interesting is what the OIG is calling a “Portfolio” that will contain a summary of their prior investigative work which will also include major recommendations for improving the hospice program.

Home Health

The one new project announced for Home Health will focus on comparing the data State agencies receive from Home Health Agencies with claims data available through Medicare. The State agencies don’t have access to CMS/Medicare claims data so the OIG will take advantage of their access and compare the data from these two sources to identify potential fraud.

Medical Equipment and Supplies

There are three new projects in this category. One focuses on CPAP, or reordering of new CPAP equipment when it may not need to be replaced. CPAP is continuous positive airway pressure and is a treatment modality for sleep apnea. The equipment is expensive and OIG has expressed concern about suppliers automatically shipping new equipment when no physician orders for refills or replacements were in effect.

Other Providers

The OIG announced five new projects and three revised projects in the category of “other providers” which includes laboratories, physicians, ambulance, ambulatory surgery centers, etc.

On the physician front, OIG will look at Medicare payments to physicians for Transitional Care Management, or TCM. Certain Medicare-covered services such as chronic care management, end-stage renal disease and prolonged services without direct patient contact cannot be billed during the same period as TCM. OIG will determine whether this has occurred.

Another area the OIG will examine as it relates to physicians is the “Sunshine” laws, which CMS calls Open Payments. Medical device and pharmaceutical manufacturers must report most transfers of value to physicians and teaching hospitals as well as ownership and investment interests held by physicians. OIG is going to analyze the 2015 data to determine the number and nature of financial interests. They will also include a determination of how much Medicare paid for drugs and equipment ordered by physicians who had financial relationships with manufacturers.

These are just some of the highlights from the OIG’s recently published 2017 Work Plan. Make sure you review the document in its entirety to determine if any of these areas are services your organization provides and consider including those areas in your own compliance program’s annual work plan.

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