Deeper Than the Headlines: Feb 2019 OIG Work Plan Additions

In February 2019, the OIG has made multiple additions to its Workplan.  There are some significant additions, so let’s look at a few of them.

Medicare Part B Payments for Podiatry and Ancillary Services

Medicare Part B covers podiatry services for medically necessary treatment of foot injuries, diseases, or other medical conditions affecting the foot, ankle, or lower leg. Part B generally does not cover routine foot-care services such as the cutting or removal of corns and calluses or trimming, cutting, clipping, or debridement (i.e., reduction of both nail thickness and length) of toenails. Part B may cover these services, however, if they are performed (1) as a necessary and integral part of otherwise covered services, (2) for the treatment of warts on the foot, (3) in the presence of a systemic condition or conditions, or (4) for the treatment of infected toenails. Medicare generally does not cover evaluation and management (E&M) services when they are provided on the same day as another podiatry service (e.g., nail debridement performed as a covered service). However, an E&M service may be covered if it is a significant separately identifiable service. In addition, podiatrists may order, refer, or prescribe medically necessary ancillary services such as x-rays, laboratory tests, physical therapy, durable medical equipment, or prescription drugs. Prior OIG work identified inappropriate payments for podiatry and ancillary services. OIG will review Part B payments to determine whether podiatry and ancillary services were medically necessary and supported in accordance with Medicare requirements.

NIH's Implementation of Financial Conflict of Interest Regulations

The National Institutes of Health (NIH) awards extramural grants to researchers working in both domestic and foreign organizations. These grants constitute more than 80 percent of the NIH's $37 billion budget. The grantee institutions where these researchers work are required to safeguard intellectual property derived from NIH-funded research in several ways, including by managing financial conflicts of interest and by reporting significant conflicts to NIH. The Departments of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and Continuing Appropriations Act, 2019 (Public Law No. 115-245) and its Accompanying Report directed that OIG examine grantees' compliance with NIH policies, including NIH efforts to ensure the integrity of grant application and selection processes and the effectiveness of NIH's and grantee institutions' efforts to protect intellectual property derived from NIH-supported research. This review will determine whether NIH has policies, procedures, and controls in place for ensuring that both foreign and domestic grantees disclose all sources of research support, financial interests, and affiliations.

Nursing Facility Staffing: Reported Levels and CMS Oversight

Staffing levels in nursing facilities can impact residents' quality of care. Nursing facilities that receive Medicaid and Medicare payments must provide sufficient licensed nursing services 24 hours a day, including a registered nurse for at least 8 consecutive hours every day. CMS uses auditable daily staffing data, called the Payroll-Based Journal, to analyze staffing patterns and populate the staffing component of the Nursing Home Compare website, a site that enables the public to compare the results of health and safety inspections, the quality of care provided at nursing facilities, and staffing at nursing facilities. The first of two reports will be a data brief that describes nursing staffing levels reported by facilities to the Payroll-Based Journal. The second report will examine CMS's efforts to ensure data accuracy and improve resident quality of care.

NIH Monitoring of Extramural Researchers' Financial Conflicts of Interest

Extramural grants awarded to researchers working at universities and other institutions constitute more than 80 percent of the National Institutes of Health's (NIH's) $37 billion budget. These grantee institutions play a key role in protecting the integrity and security of U.S. biomedical research by managing their researchers' financial conflicts of interest and reporting significant conflicts to NIH, as required by regulation. Recently, the Director of NIH issued a statement expressing concern about the increasing risks to the security of intellectual property in its biomedical research enterprise. NIH stated that it is addressing these concerns, in part, by taking steps to improve accurate reporting of all financial interests. Grantee institutions must submit sufficient information that would enable NIH to both (1) understand the nature and extent of a researcher's financial conflict of interest and (2) assess the appropriateness of the grantee institution's plan to manage this conflict. The Departments of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and Continuing Appropriations Act, 2019 (Public Law No. 115-245) and its Accompanying Report directed that OIG examine NIH's oversight of its grantees' compliance with NIH policies, including NIH efforts to ensure the integrity of its grant application and selection processes and to protect intellectual property derived from NIH-supported research. OIG will examine NIH's oversight and monitoring of the financial conflicts of interest reported by grantee institutions.

There are other additions in February’s Workplan.  Make sure to look at the other items as well.