The Office of the Inspector General (OIG) recently released its Work Plan for Fiscal Year 2015. There are a number of new items on the Work Plan which affect hospitals, nursing facilities, community health centers, and independent clinical laboratories. Set forth below is a summary of some of the new items which may be of interest to our health care clients.
Billing and Payments
Review of Hospital Controls over the Reporting of Wage Data Used to Calculate Medicare Payments
Hospitals are required to report accurate wage data to the Centers for Medicare and Medicaid Services (CMS) on an annual basis. The data is used to calculate wage indexes for Medicare payments. Prior work by the OIG revealed hundreds of millions of dollars of incorrectly reported wage data.
Quality of Care and Safety
Expansion of Post-Acute Care Quality of Care and Safety Review to Include Adverse Events for Medicare Beneficiaries in Long-Term Care Hospitals
The OIG intends to estimate the national incidence of adverse events and temporary harm experienced by Medicare beneficiaries in long-term care hospitals, identify the factors that contribute to these events, determine the extent to which these events were preventable, and estimate the associated costs to the Medicare program.
Review of Hospital Compliance with Electronic Health Record System Contingency Plans
The security rule provisions of the Health Insurance Portability and Accountability Act (HIPAA) applicable to electronic health records require covered entities to have a contingency plan that establishes policies and procedures for responding to an emergency or other occurrence that damages systems that contain protected health information. The OIG intends to compare hospitals’ contingency plans with government and industry recommended practices.
Nursing Facilities and Group Homes
Investigation of Medicaid Beneficiary Emergency Transfers from Group Homes and Nursing Facilities to Hospital Emergency Rooms
The OIG is concerned that high occurrences of emergency transfers from nursing facilities or group homes to hospitals could be indicative of poor quality. Prior work by the OIG examining transfers from nursing facilities to hospital emergency departments raised concerns about the quality of care provided in the nursing facilities.
Review of Independent Clinical Laboratory Billings and Payments
The OIG intends to examine whether independent clinical laboratories are in compliance with certain Medicare billing requirements. Based on the results of its review, the OIG will identify clinical laboratories that regularly submit improper claims and will recommend that recoveries of overpayments be made. Prior OIG audits identified independent clinical laboratories as an area at risk for noncompliance with Medicare billing requirements.
Community Health Centers – Compliance with Grant Requirements of the Affordable Care Act
The OIG will review whether community health centers that receive grants under the Affordable Care Act are in compliance with federal laws and regulations governing the receipt of such funds, including whether the expenditures are allowable and the accounting systems that assess and account for program income are adequate.
If you have questions about the OIG’s 2015 Work Plan, or any concerns regarding your organization’s compliance with the items in the Plan, please contact Rochelle H. Zapol, a partner in Prince Lobel’s Health Care Practice Group and the author of this alert. You can reach Rochelle at 617 456 8036 or rzapol@PrinceLobel.com.