Summary
In November 2015, the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) released its investigative plans for fiscal year 2016 (the OIG Work Plan). The OIG Work Plan highlights more than 40 new areas of inquiry that will be pursued by the OIG in the upcoming fiscal year. In addition to the new inquiries, the OIG Work Plan highlights areas of continued focus by the various OIG departments: Office of Audit Services; Office of Evaluation and Inspections; Office of Investigations; Office of Counsel to the Inspector General; and Executive Management.
The release of the OIG Work Plan is a blueprint for all participants in the health care delivery system - providers, payors and other vendors - to understand where and how OIG will spend its resources during the current fiscal year. All participants in the health care delivery system should carefully review the OIG Work Plan, understand the OIG’s areas of focus and ensure that they are in compliance with the applicable statutes and regulations.
As in previous years, the OIG Work Plan focuses on the following areas: Medicare Part A and Part B; Medicare Part C and Part D; Medicaid; Centers for Medicare and Medicaid Services (CMS)-Related Legal and Investigative Activities; Public Health Reviews; and Affordable Care Act Reviews.
Several of the new OIG Work Plan initiatives include:
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medical device credits for replaced implanted medical devices;
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skilled nursing facility prospective payment system requirements;
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Medicare fee schedule for orthotic braces;
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Medicare’s quality oversight of ambulatory surgical centers;
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physician referring/ordering of Medicare services and supplies;
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Medicare Part B claims for anesthesia services;
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review of the performance of accountable care organizations participating in the Medicare Shared Savings Program;
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management of the ICD-10 implementation by CMS;
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specialty drug pricing and reimbursement in Medicaid;
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review whether the U.S. Food and Drug Administration’s oversight of hospitals’ networked medical devices is sufficient to protect electronic protected health information; and
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assess the Office of Civil Rights’ oversight of the security of electronic protected health information.
A copy of the 2016 OIG Work Plan is available here.
In the introduction to the 2016 Work Plan, the OIG stated that for fiscal year 2015, the OIG expected recoveries in excess of $3 billion. Approximately one-third of the recoveries were from audits and the balance was from investigations. More than 4,000 individuals and entities were excluded from participating in federal health care programs during fiscal year 2015, and there were more than 900 criminal actions and almost 700 civil actions.
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