On Monday, November 2, the Office of Inspector General ("OIG") for the U.S. Department of Health and Human Services ("HHS") published its investigative plan for 2016. According to the plan, the OIG intends to focus on "additional oversight of hospice care, including oversight of certification surveys and hospice-worker licensure requirements; oversight of Skilled Nursing Facilities’ (SNF) compliance with patient admission requirements; and evaluation of CMS’s Fraud Prevention System."
The OIG has identified over 40 new inquiries affecting hospitals, nursing homes, medical equipment and supply companies, ambulatory surgery centers and other health care organizations. The inquiries cover a broad range of topics, including pharmacy fraud, increased drug prices and cybersecurity of medical devices. It should come as no surprise that increased drug prices have become a focus of OIG concern, with recent Congressional attention to this issue, and attendant media attention. In addition, the OIG will continue to review Medicare reimbursements, including payments for outpatient care during inpatient admissions, anesthesia services, ventilators and related respiratory devices, orthotic braces, replaced medical devices and physician home visits.
The investigative plan confirms that combating health care fraud and abuse remains a top priority for the OIG and HHS in 2016. Areas that will see continued and potentially increased investigative activity include: diagnostic radiology and laboratory testing; durable medical equipment; ambulance transportation; home health agencies, personal care, and home and community based services; and controlled and non-controlled prescription drugs.
The new ICD-10 coding system, implemented on October 1, 2015, comes under scrutiny, as the OIG plans to evaluate the overall implementation of the new system by the Centers for Medicare & Medicaid Services.