New OIG Work Plan Updates for April 2025

Senior Medicare Patrol Projects

In 1997, a recommendation in a congressional committee associated with legislation created an initiative involving seniors’ efforts to prevent Medicare fraud, waste and abuse. The efforts are formalized through the Administration for Community Living's Senior Medicare Patrol (SMP). These projects recruit and train retired professionals and other volunteers to prevent, recognize, and report health care fraud, errors, and abuse.  

OIG plans to review the 2024 SMP project performance data and documentation relating to Medicare and Medicaid recoveries, savings, and cost avoidance. The Administration for Community Living requested this information, which will support its efforts to evaluate and improve the performance of the SMP projects. 

Past reports demonstrate the successes of these seniors’ efforts. The most current past report is the 2023 Performance Data for the Senior Medicare Patrol Projects and can be found here: 

https://oig.hhs.gov/reports/all/2024/2023-performance-data-for-the-senior-medicare-patrol-projects/  

Indian Health Service Sanitation Facilities Construction Projects 

Through legislation, Congress allocated a total of $3.5 billion over 5 years to the Indian Health Service Sanitation Facilities Construction (SFC) Program to provide American Indian and Alaska Native people with essential water supply, sewage disposal, and solid waste disposal facilities.  

The OIG is going to review data for the first 3 fiscal years, 2022 through 2024, to:  

1. Provide a national snapshot of how IHS used and managed funds for its SFC Program 
2. Highlight any challenges that IHS faced to administer SFC Program projects and actions taken to address those challenges. 

Skilled Nursing Facilities and Medicare Part D Enrollees' Drugs in Part A Stays

Medicare Part A prospective payments to skilled nursing facilities (SNFs) cover most services, including drugs and biologicals, furnished by a SNF for use in the facility for the care and treatment of enrollees.  

Because of this, Medicare Part D drug plans should not pay for prescription drugs related to post-hospital SNF care, because payment for the drugs is included in the prospective payment for a Part A SNF stay.  

A prior OIG audit found that up to $465.1 million in Part D total cost was improperly paid for drugs for which payment was available under the Part A SNF benefit. (see: https://oig.hhs.gov/reports/all/2024/medicare-part-d-paid-millions-for-drugs-for-which-payment-was-available-under-the-medicare-part-a-skilled-nursing-facility-benefit/#:~:text=On%20the%20basis%20of%20our,the%20Part%20A%20SNF%20benefit.)  

That audit also found that some of the drugs administered to Part D enrollees during their Part A SNF stays had been provided to the SNFs by the enrollees or their families, even though the SNFs were financially responsible for providing the drugs.  

For this audit, OIG plans to determine whether SNFs complied with Federal requirements for assuming financial responsibility for drugs for Part D enrollees in Part A SNF stays. For instances in which drugs used during enrollees' Part A SNF stays were provided by the enrollees or their families and paid for by Part D, OIG will determine why the SNFs obtained the drugs from the enrollees or their families. 

Oversight of New Medicare Hospice Provider Enrollments

Federal requirements state that hospices must be certified by CMS and be licensed as required by State and local law. Medicare also requires that hospices meet its Conditions of Participation to receive payment.  

The OIG’s objective for this work plan item is to identify trends, patterns, and key comparisons that indicate potential vulnerabilities related to new Medicare hospice provider enrollments. The data brief may help CMS evaluate the need for additional monitoring and program integrity efforts to ensure that hospices meet all the requirements.  

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