The OIG recently issued its annual Work Plan for FY 2012. Of particular interest are the initiatives related to PPACA, as well those evaluating the effectiveness of programs initiated or funded by the American Recovery and Reinvestment Act of 2009 (ARRA).
PPACA-focused work planned by the OIG includes several Medicare-related reviews, such as the POA (present on admission) indicators relevant to payment reductions to hospitals with high rates of hospital-acquired conditions; studies of the rate of same-day admissions; operationalization of compliance plans of skilled nursing facilities and various reviews of rates, quality and coverage issues under the Medicare Part C (MA) program. For Medicaid, the OIG will review the new methodology for computing federal upper payment limit amounts required by PPACA, assess drug utilization with respect to Medicaid rebates offered under PPACA, as well as healthcare-acquired conditions, coding and Medicaid Statistical Information System effectiveness. In the public health area, the OIG plans to review the appropriate utilization of PPACA grants to various agencies and individuals, the compliance and capabilities of community health centers receiving PPACA funds and the effectiveness of the National Health Service Corps and Prevention and Public Health Funds.
ARRA-related work planned by the OIG in FY 2012 includes reviews of Medicare and Medicaid incentive payments for Meaningful Use of Electronic Health Records (EHR) to determine whether improper incentive payments have been made. Medicare and Medicaid information systems will be reviewed for security and privacy issues, particularly the effectiveness of breach notification and medical identity theft prevention programs, agency contractor system enhancements to ensure security of sensitive EHR and personal information and reviews of the Office of Civil Rights' oversight of the HIPAA privacy and security regulations.
With respect to the other audits and reviews that will be conducted by OIG in FY 2012, the following are a few brief highlights of new activities and recurring reviews that will be affecting some key healthcare providers and suppliers. There are many more activities not covered here, so providers and suppliers are advised to review all Work Plan sections related to their specific industry segment.
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