The Office of Inspector General (OIG) has released its 2014 Work Plan. The Work Plan summarizes activities OIG plans to pursue with respect to the U.S. Department of Health and Human Services (HHS) programs and operations.
The Work Plan can be an important resource for identifying potential compliance risk areas. It is divided into the following sections: (1) Medicare Part A and Part B; (2) Medicare Part C and Part D; (3) Medicaid Program; (4) CMS-Related Legal and Investigative Activities; (5) Public Health Reviews; (6) Human Services Reviews; and (7) Other HHS-Related Reviews. It discusses OIG activities regarding hospitals, nursing homes, hospices, home health services and other community based care, medical equipment, prescription drugs, and other providers and suppliers.
Notably, the Legal and Investigative Activities section addresses exclusions from federal healthcare programs and the imposition of civil monetary penalties, pursuit of False Claims actions and assessment of compliance with Corporate Integrity Agreements, the advisory opinion process, and initiatives regarding provider compliance training and self-disclosure. It also describes the Health Care Fraud Prevention and Enforcement Action Team (HEAT), started in 2009, and the Medicare Fraud Strike Force teams, which coordinate efforts of federal, state and local law enforcement.
While there is similarity between the new Work Plan and the OIG’s previous Work Plans, OIG introduces several new areas that include, new inpatient admission criteria, analysis of salaries included in hospital cost reports, outpatient evaluation and management services billed at the new-patient rate, indirect medical education payments, oversight of hospital privileging, accuracy of the Physician Compare Web Site and hospice in assisted living facilities.
Click here to view the 2014 Work Plan.