OIG March 2019 Work Plan

PUBLISHED: Mar 18, 2019
Relevant to: All Healthcare Organizations

The Office of the Inspector General (OIG) recently released updates to their Work Plan. In 2017, OIG transition from a yearly to a monthly Work Plan with the goal of enhancing transparency around OIG's continuous work planning efforts. For March 2019, the follow selection of OIG Work Plan activities are of interest to healthcare organizations:

Opioid Use in Medicare Part D in States in the Appalachian Region: Overdose deaths are at epidemic levels and the opioid crisis is now considered a public health emergency. According to OIG, in 2016, there were more than 42,000 opioid-related overdose deaths in the United States. Nearly 7,000 of these deaths occurred in five States in the Appalachian region-Alabama, Kentucky, Ohio, Tennessee, and West Virginia. Identifying beneficiaries who are at risk of overdose or abuse is key to addressing this national crisis. This OIG data brief will provide data on prescription opioid use in Medicare Part D in these five States in 2017, including the proportion of Medicare beneficiaries who received a prescription opioid and the number of beneficiaries who are at serious risk of opioid misuse or overdose.

Post-Hospital Skilled Nursing Facility Care Provided to Dually Eligible Beneficiaries: OIG will determine whether the post-hospital skilled nursing facility (SNF) care provided to dually eligible beneficiaries met the level of care requirements. Specifically, OIG will determine whether (1) the SNF level of care was certified by a physician (e.g., a hospital or SNF physician) or a physician extender (i.e., a nurse practitioner, clinical nurse specialist, or physician assistant); (2) the condition treated at the SNF was a condition for which the beneficiary received inpatient hospital services or a condition that arose while the beneficiary was receiving care in a SNF for a condition for which the beneficiary received inpatient hospital services; (3) daily skilled care was required; (4) the services delivered were reasonable and necessary for the treatment of a beneficiary's illness or injury; and (5) improper Medicare payments were made on the claims we review. OIG will also determine whether any of the hospital admissions we review were potentially avoidable.

The OIG Work Plan provides insight into areas where government enforcement and audit officials are focusing. For more information follow the link below. Included with today’s StayAlert! Notice are example policies that may assist with identified audit areas. For additional resources see MCN Healthcare’s Long Term Care Policy and Procedure manual.

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