Corporate Compliance

2005 OIG Work Plan reveals gov’t target areas

Compliance Monitor, October 20, 2004

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The OIG will continue to focus on long-running audits and evaluations in its Work Plan. Released October 12, it lists projects it expects to study in the next year, many of which are potential causes of fraud, waste, and abuse.

"In the 2005 Work Plan, there is a tremendous amount of continuation of audit and evaluation work from prior OIG Work Plans," says Howard Young, Esq., a partner with Sonnenschein, Nath & Rosenthal LLP in Washington, DC.

The Work Plan shows how much time the OIG must now devote to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) implementation, says Young, including implementation and drug-pricing issues. However, the OIG won't be taking its eye off hospitals, labs, and physician practices, he says. The agency will continue to focus on medical necessity and perform medical reviews, says Young. Hospital-related projects slated for next year include:

  • Postacute care transfers-The OIG will assess contractors' ability to limit payments to hospitals for patients who are discharged from a prospective payment system inpatient hospital and admitted to one of several postacute-care settings.

  • Rebates paid to hospitals-The OIG will determine whether hospitals are properly identifying purchase credits as a separate line item in their Medicare cost reports. This study is an outgrowth of the audit work the OIG is doing with group purchasing organizations, says Young.

  • Inpatient rehabilitations payments for late assessments-The OIG will determine the accuracy of Medicare payments for inpatient rehabilitation stays when patient assessments are entered late.

    Editor's note: To read the Work Plan, click here.

    For more news and analysis on the Work Plan, see the November issue of Strategies for Health Care Compliance.



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