Mid-year Update to OIG Work Plan

June 28, 2016
News & Insights

Earlier this month, the OIG released its Work Plan Mid-year Update for FY 2016 (Update). The Update is a summary of new and ongoing reviews and activities the OIG plans to pursue with respect to HHS programs and operations during the current FY and beyond. The OIG has broad oversight for more than 100 programs administered by various HHS agencies concerned with the health of the nation, including CMS, the CDC, the Food and Drug Administration, and the NIH.  

During FY 2016, the OIG has focused its Medicare oversight efforts on identifying and offering recommendations to reduce improper payments, prevent and deter fraud, and foster economical payment policies across the broad spectrum of healthcare facilities and practitioners. Today we will focus only on that portion of the Update related to short-term, acute-care hospital services covered under Medicare Parts A and B, which together are sometimes referred to as “Original” Medicare or “Fee-for-service” Medicare. For the remainder of FY 2016 and beyond, the OIG will continue to focus on a number of new, revised, and ongoing issues related to these hospital services.

Hospital issues identified in the Update

The OIG introduced two new issues for review:

  • Outpatient outlier payments—OIG will explore the potential for savings if hospital outpatient services were ineligible for cost outlier payments; prior reports have concluded that a hospital’s high charges, unrelated to cost, lead to excessive inpatient outlier payments; and,
  • Intensity-modulated radiation therapy (IMRT)—OIG will review Medicare outpatient payments for IMRT to determine whether the payments were made in accordance with federal requirements; in particular, certain services should not be billed when performed as part of developing an IMRT plan. 

The OIG also made slight revisions to the following items, which were part of the original FY 2016 Work Plan:

  • Medicare oversight of provider-based status—OIG will determine whether those facilities identified as provider based meet the regulatory requirements and whether such status justifies higher payment; the Medicare Payment Advisory Commission has expressed concerns that Medicare should pay similar amounts for similar services; this correlates with another ongoing OIG review comparing Medicare payments for physician office visits in provider-based clinics versus freestanding clinics;
  • Analysis of salaries listed in hospital cost reports—OIG will analyze the amounts of salaries included in Medicare cost reports, report on the range of salaries, and determine the cost savings that could be achieved at various federal compensation benchmarks.

Finally, the OIG will continue its ongoing review of the other items, as set out in the original FY 2016 Work Plan.

To view the complete, detailed article that appeared on Medicare Compliance Watch, click here.