On January 31, 2014, the Department of Health and Human Services Office of Inspector General (OIG) released its work plan for fiscal year 2014. The work plan identifies the programs OIG will review in the upcoming year. The work plan also provides updates for OIG’s ongoing projects listed in previous work plans, and identifies new work on OIG’s docket. Certain new projects OIG will focus on in 2014 include:
- Analyzing the two-midnight rule and its impact on hospital billing and Medicare payments;
- Reviewing Medicare costs associated with defective medical devices and the resulting impact on the Medicare trust fund;
- Comparing Medicare payments for similar services performed in provider-based or free-standing clinics in order to assess the impact on the Medicare program of providers claiming provider-based status;
- Determining whether teaching hospitals are receiving indirect medical education payments calculated in accordance with Federal regulations; and
- Evaluating OIG audits and investigations relating to Medicare Part B ambulance services to determine fraud trends and recommend techniques to minimize inappropriate payments for ambulance services.
The work plan also identifies several areas of oversight related to implementation of the Patient Protection and Affordable Care Act. In 2014, OIG will focus on the operation of the new Health Insurance Marketplaces. It has prioritized four key areas to ensure that the Marketplaces operate effectively and taxpayer funds are used appropriately: (i) payment accuracy, (ii) eligibility systems, (iii) contracts, and (iv) security of data and consumer information. OIG will also monitor and review the expansion of Medicaid. The 2014 work plan is available here.