The HHS OIG has updated its FY 2016 Work Plan to reflect new and/or completed items since initial release of the FY 2016 Work Plan in November 2015. For instance, the mid-year update indicates that the OIG plans to conduct several new Medicare reviews, including reviews regarding:

  • The extent of potential Medicare savings if hospital outpatient stays were ineligible for outlier payment;
  • The appropriateness of Medicare outpatient payments for intensity-modulated radiation therapy;
  • Compliance with the skilled nursing facility prospective payment system requirement related to a three-day qualifying inpatient hospital stay;
  • Potentially-avoidable hospitalizations of nursing home residents for urinary tract infections;
  • Implementation of the national background check program for long-term-care employees;
  • The prevalence of Medicare home health fraud;
  • Implementation of the new Medicare payment system for clinical diagnostic laboratory tests;
  • Beneficiary assignment to accountable care organizations under the Medicare Shared Savings Program;
  • Price increases for brand-name and generic drugs under Medicare Part D; and
  • Part D billing trends, including trends related to compounded drugs and commonly-abused opioids.

Additional reviews are planned for other HHS program areas, including reviews regarding whether Medicare requirements for processing physician-administered drug claims impact state Medicaid agencies’ ability to correctly invoice Medicaid drug rebates for dual eligible enrollees, along with a review of whether states comply with health care-related tax requirements.