The OIG released several new Work Plan items in October. Here’s what compliance teams need to know and why it matters.
The OIG issued several new Work Plan additions in October, each with significant implications for hospitals, health systems, payers, and compliance leaders.
This month’s focus includes Medicaid transportation billing, managed care oversight, Medicare Advantage drug pricing, and behavioral health assessments for new enrollees.
Key Areas of Focus
- Nonemergency Medicaid Transportation: Targeted reviews using billing indicators to identify fraudulent or noncompliant claims—and estimate potential savings.
- Managed Care Cost Controls: A review of states that have (or have not) enforced medical loss ratio minimums and collected remittances from under-performing MCOs.
- 340B & Part B Drugs in Medicare Advantage: Evaluation of how MA plans manage 340B data and what inflation rebates could mean for federal savings.
- Behavioral Health Assessments: A look at whether states and MCOs are completing required assessments for newly enrolled adults within 90 days.
Stay ahead of Work Plan developments and learn how these reviews may impact audits, internal controls, and risk management across Medicaid and Medicare programs.