February 2025 OIG Work Plan Updates: What’s Changing?

The OIG added multiple Work Plan items in February 2025. Let’s take a closer look at the items that may affect your organization. 

Surety Bonds to Protect Medicare

For many years, Medicare Part B has been susceptible to fraudulent durable medical equipment (DME) suppliers. In an attempt to limit the risk that fraudsters pose, CMS implemented a surety bond requirement in 2009 that held promise as a tool to: (1) deter fraud and (2) recover overpayments.  

In 2013, OIG reported that CMS underutilized surety bonds as a tool to protect Medicare from overpayments to DME suppliers. According to the OIG, CMS has only recovered $263,000 from surety bonds of $50 million in overpayments identified for collection between October 2009 and April 2011.  

OIG is added this Work Plan item to update and expand upon this topic. They plan to determine:  

1. The total amount of outstanding DME overpayments that became eligible for surety bond collection in CY 2023. 
2. The total amount of outstanding DME overpayments that have been collected and left uncollected from surety bonds. 
3. Potential obstacles DME Medicare Administrative Contractors and CMS face in collecting outstanding DME overpayments from surety bonds. 
4. Potential changes that could make surety bonds a more effective tool to deter fraud and recover DME overpayments. 

NIH and Royalties

According to the OIG, Congress has expressed concerns over certain NIH royalty payments and, separately, private companies potentially profiting from NIH exclusive licenses for intellectual property that is invented by NIH. 

Various members of Congress have proposed legislation called the Royalty Transparency Act https://www.hsgac.senate.gov/wp-content/uploads/S.-3664_As-Introduced-1.pdf and https://morgangriffith.house.gov/uploadedfiles/royalty_transparency_act.pdf.  

The NIH licenses its inventions and intellectual property to private companies for further development and commercialization. Exclusive and nonexclusive patent licenses allow a company to develop and commercialize an NIH invention, under appropriate circumstances, for a specific use and according to applicable statutes and regulations. In return, when a licensee brings the product to market, NIH collects royalty payments, which are usually based on the product's sales. NIH then makes royalty distributions to NIH inventors and NIH institutes and centers.  

The OIG has added this work plan item to determine whether NIH: 

1. Monitored compliance with its exclusive commercial licensing agreements, and  
2. Collected and distributed royalty payments in accordance with Federal requirements. 

Noncovered Versions of Part B Drugs

When the Consolidated Appropriations Act of 2021 was put into law, certain provisions required CMS to remove noncovered self-administered versions of Cimzia and Orencia from Part B payment amount calculations beginning in July 2021. 

The same law required OIG to conduct studies to identify additional drugs for which noncovered self-administered versions are included in Part B payment amounts, and to determine whether they should be excluded from Part B payment amount calculations.  

This work plan item is in response to these requirements. As such, OIG will conduct periodic studies identifying drugs for which noncovered self-administered versions were included in Part B payment amounts.  

In general, for the drugs that OIG identifies, CMS is required to remove noncovered self-administered versions from payment amount calculations in subsequent quarters if the exclusions would result in lower payment amounts; however, the statute gives CMS some discretion in addressing the requirement. 

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