The Office of the Inspector General's (OIG) Work Plan sets forth projects such as OIG audits and evaluations that are underway or planned to be addressed in the fiscal year and beyond. Instead of providing the annual Work Plan we were previously accustomed to; the OIG is providing monthly updates that include the addition of newly initiated Work Plan items. The OIG will also be removing completed items. This will allow updates regarding planned, ongoing, and published work.
December Recently Added Items
December 2017 was a relatively quiet month with only six recently added items. Below is a list of the added items and what OIG is and will be working on:
- Status Update on States' Efforts on Medicaid-Provider Enrollment OIG will determine the extent to which States have completed fingerprint-based criminal background checks and site visits. In addition, we will ask States and CMS about challenges that prevent States from completing fingerprint-based criminal background checks and site visits.
- Review of CMS Systems Used to Pay Medicare Advantage (MA) Organizations OIG will review the continuity of data maintained on current Medicare Part C systems. OIG will review instances in which CMS made an increased payment to an MA organization for hierarchical condition categories (HCC) and determine whether CMS's systems properly contained a requisite diagnosis code that mapped to that HCC.
- State Compliance with Requirements for Reporting and Monitoring Critical Incidents OIG will review additional State Medicaid Agencies to determine whether the selected States are in compliance with the requirements for reporting and monitoring critical incidents. OIG will focus on Medicaid beneficiaries residing in both community-based settings and nursing facilities.
- Paper Check Medicaid Payments Made to Mailbox-Rental Store Addresses A report by the Government Accountability Office identified potential issues with Medicare-provider addresses and revealed that payments made to a provider with a mailbox-rental store, vacant, or invalid practice address increase the potential risk of fraud, waste, or abuse. OIG will assess whether similar problems exist with the Medicaid program. Specifically, OIG will determine if Medicaid payments issued by paper checks and sent to providers with mailbox-rental locations were for unallowable services.
- Prescription Opioid Drug Abuse and Misuse Prevention Prescription Drug Monitoring Programs OIG's objectives are to identify actions State agencies have taken using Federal funds for enhancing prescription drug monitoring programs (PDMPs) to achieve program goals improving safe prescribing practices and preventing prescription drug abuse and misuse. OIG will also determine whether State agencies complied with Federal requirements. This series of audits includes States that have had a high number of overdose deaths, have a significant increase in the rate of drug overdose deaths, or received HHS funding to enhance their PDMPs.
- Impact of the Indian Health Service's Delivery of Information Technology/Information Security Services and Opioid Prescribing Practices OIG will analyze and compare information technology/information security (IT/IS) operations and opioid prescribing practices at five Indian Health Service(IHS) hospitals to determine whether (1) IHS's decentralized management structure has affected its ability to deliver adequate IT/IS services in accordance with Federal requirements and (2) hospitals prescribed and dispensed opioids in accordance with IHS policies and procedures.
Healthcare Compliance Pros will be monitoring the OIG's Work Plan on a monthly basis and providing updates to be aware of. If you have any questions please reach us by email: [email protected] or by phone: 855-427-0427.