In the News: Office of the Inspector General’s 2008 Workplan

Earlier this month, the Office of the Inspector General [OIG] released its Fiscal Year 2008 workplan. This 111-page document once again provides information on the initiatives to be undertaken by the OIG on behalf of Centers for Medicare and Medicaid Services [CMS] programs. Overall The OIG utilizes about 80% of its resources in CMS related work.

The workplan is divided into several sections and includes both Medicare and Medicaid initiatives. Each of the sections is subdivided into provider settings or reimbursement programs, including under:

• Medicare: Hospitals, home health, nursing homes, hospice care, physicians, health professionals, medical equipment and supplies, Part B drug reimbursement, Part D administration, other services, such as inpatient dialysis, laboratory services, emergency services to undocumented aliens, Medicare Advantage program, contractor operations and cross-cutting issues, such as serious medical errors, and doctor’s office quality information technology initiatives.

• Medicaid: Hospitals, long-term and community care, mental health services, state children’s health insurance program, prescription drugs and other services, such as family planning, transportation services, adult rehabilitative services, laboratory services, inpatient and outpatient alcoholism and substance abuse, medical equipment and Medicaid administration.

Public health programs and human services programs are also identified for specific 2008 workplan initiatives within this document.

Of interest is a review undertaken by this workplan to look at the deemed status process in relationship to the Joint Commission by which hospitals meet the Medicare Conditions of Participation. The results of this review will be of interest to all providers, including home health and hospice providers who use the deemed status option in their accreditation process. Specific home health studies in the 2008 workplan include:

• Home Health Agencies Cyclical Noncompliance Data Study
• Home Health Compare Web Site Data Accuracy
• Home Health Resource Groups Coding and Claims Accuracy

Hospice Care

• Nursing Home Residents: Appropriate Hospice Care Services and Payments
• Hospice Beneficiary Duplicate Drug Claims

Medical Equipment and Supplies

• Home Health Services Beneficiaries – Durable Medical Equipment Payments
• Medicare Part B -Home Blood Glucose Testing Supplies
• Pressure-Reducing Support Surfaces Appropriateness
• Power Wheelchairs Payments

For the specific time frames of these studies and more information about their components, the entire workplan is available at www.oig.hhs.gov. Using this document as a tool for educating and inservicing staff assists the organization to prepare for the anticipated reviews and investigations. This education prepares the organization to be ready for the impact of the studies on operations and to proactively address the medical record review elements that will be scrutinized as these studies move forward from the planning stage into implementation and completion.

Resource: Office of the Inspector Workplan Fiscal Year 2008. Department of Health and Human Services. Washington DC.