OIG Adds Seven New Work Plan Projects in May.

2018 OIG Work Plan Monthly Update: May

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently issued seven updates to its OIG Active Work Plan (“Work Plan”).  The Work Plan outlines ongoing and planned audits and evaluations for the fiscal year and beyond.  In 2017, the OIG began releasing its Work Plan projects on an ongoing basis, rather than providing biannual updates.  The new format includes an ongoing list of “Active Work Plan Items”, which includes newly initiated Work Plan items and notifications of completed items.  The OIG assesses relative risks in HHS programs and operations to identify those areas most in need of attention.  The OIG considers several factors when creating Work Plan items, including legal mandates, congressional requests, budgetary concerns, potential for positive impact, and others.  In addition to working on projects that often lead to audits, reviews, and reports, the OIG also engages in a number of legal and investigative activities that are separately reported.

May 2018 Additions to the OIG Work Plan

1. 2017 Hurricane Emergency Preparedness and Response Efforts.

• After the 2017 hurricanes, HHS received $5.97 billion in supplemental funds for hurricane preparedness and response efforts. The OIG will review HHS’s oversight of programs and funds expended and also  assess and audit HHS’s identified primary risks for hurricane preparedness and response.

2. Examining Healthcare Coalitions’ Partnerships with Non-Hospital-Based Facilities in Community Preparedness Efforts.

• Healthcare Coalitions (HCC) are groups of public and private health care organizations, emergency preparedness planners, responders, and other types of health officials in specified jurisdictions. HCCs receive funding through the Office of the Assistant Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program (HPP).  HPP guidance encourages HCCs to create emergency response plans for vulnerable populations that depend on non-hospital-based facilities for monitoring and care during and after disasters.  The Centers for Medicare and Medicaid Services (CMS) implemented new emergency preparedness requirements that apply to all facilities receiving Medicare and Medicaid reimbursement.  Although HPP and CMS emergency preparedness requirements are components of different programs, the implementation of each is affected by the other.  The OIG will examine HCCs’ integration of non-hospital-based facilities into their emergency preparedness activities and technological strategies while also assessing ASPR’s oversight and support.

3. The Impact of Authorized Generics on Medicaid Drug Rebates.

• In CMS’s final rule implementing provisions of the Affordable Care Act, CMS directed primary manufacturers to include in their calculation of average manufacturer price (AMP) the sale of authorized generic drugs to secondary manufacturers in certain circumstances. The OIG will examine certain drugs with authorized generics to determine how the sale of those drugs to secondary manufacturers affects Medicaid drug rebates.

4. Medicare Part B Outpatient Cardiac and Pulmonary Rehabilitation Services.

• Medicare Part B covers outpatient cardiac and pulmonary rehabilitation services, if they are medically necessary and comply with certain documentation requirements. The OIG will assess whether Medicare payments for these services were allowable based on Medicare requirements.

5. Noninvasive Home Ventilators – Compliance with Medicare Requirements.

• Medicare covers noninvasive home ventilators (NHVs) and respiratory assist devices (RADs), if they are reasonable and necessary for the diagnosis and treatment of illness or injury or to improve the functioning of a malformed body member. The severity of the beneficiary’s condition is how a determination is made on whether a NHV or RAD was reasonable and necessary.  Since Medicare billing has increased for NHVs in the years since they have been introduced to the market, the OIG will determine whether claims for NHVs were medically necessary and if they complied with Medicare payment and documentation requirements.

6. Recommendation Follow Up – 2014 OIG Report: Vulnerabilities in the HHS Small Business Innovation Research Program.

• In 2011, HHS provided Small Business Innovation Research (SBIR) funds through four Operating Divisions (OpDiv): National Institutes of Health (NIH), U.S. Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and Administration for Children and Families (ACF). However, the OIG found that 31 percent of awardees that year had questionable or unverified eligibility for at least one requirement and only one OpDiv checked for duplicative funding within HHS.  As a result, the OIG provided HHS with two open recommendations: (1) ensure compliance with SBIR eligibility requirements; and (2) improve procedures to check for duplicative awards.  The OIG will review the progress HHS has made in implementing these two recommendations.

7. States’ Procurement of Private Contracting Services for the Medicaid Management Information System.

• The Medicaid Management Information System (MMIS) is an integrated group of procedures and computer processing operations designed to meet specific objectives such as processing medical claims. Medicare reimburses states’ MMIS administrative costs at rates of 90 and 75 percent.  Many states use private contractors to design, develop, and operate their MMIS.  States are required to follow the same policies and procedures used for procurements paid with non-federal funds and must receive CMS’s prior approval to receive enhanced federal matching funds for MMIS administrative costs for private contractors.  The OIG will determine if selected states followed applicable federal and state requirements related to procuring private MMIS contracting services and claiming federal Medicaid reimbursement.