OIG Updates OIG Work Plan with Four New Projects.

The OIG recently issued four updates to its 2017 OIG Work Plan (“Work Plan”). The August updates include four new projects for 2017. The Work Plan outlines ongoing and planned audits for the fiscal year and beyond. In June 2017, the OIG announced that it would make monthly adjustments to the Work Plan, rather than issuing semi-annual updates. The monthly updates add new items and remove completed tasks from the Work Plan. The monthly update schedule will ensure that the Work Plan closely aligns with the OIG’s work planning process.

August additions to the 2017 Work Plan include the following:

1. Review of Patient Safety Organization Program (PSO).

• The federal PSO program, implemented in 2008, is the first and only comprehensive, nationwide patient safety reporting and learning system. The program works with health care providers to improve patient care safety and quality. In this review, the OIG plans to examine the PSO program’s reach and value to hospitals. The OIG will also examine the Agency for Healthcare Research and Quality (AHRQ)’s oversight of the PSO program and related challenges.

2. Duplicate Drug Claims for Hospice Beneficiaries.

• The Medicare Part A Hospice Benefit pays hospice providers a per diem amount for each individual who elects hospice coverage. The per diem rate covers the cost of prescription drugs related to terminal illness. As such, Medicare should not make Part D payments for those prescription drugs covered in the beneficiary’s Part A hospice benefit. For this review, the OIG will determine the extent to which Medicare continues to pay for double claims submitted for these prescription drugs. This audit will follow up on previous OIG work performed on this topic.

3. Medicare Part B Payment for Psychotherapy Services.

• Medicare Part B covers the treatment of mental illness and behavioral disturbances by a qualified provider who establishes professional contact with a patient. Previous OIG work has found that these outpatient psychotherapy services are prone to inappropriate billing practices. For example, the OIG found that Medicaid paid for a large number of non-covered, medically unnecessary or improperly documented services. Accordingly, the OIG will review Part B payments for psychotherapy services to examine their appropriateness under Medicare requirements.

4. Ventilation Devices: Reasonableness of Medicare Payments Compared to Amounts Paid in the Open Market.

• Medicare’s Ventilation device reimbursement has risen by over $20 million between 2011 and 2015. In an effort to review wasteful expenditures, the OIG plans to examine whether Medicare and beneficiary’s costs for these devices are reasonable as compared to the open market prices.

The OIG Workplan is available at: https://oig.hhs.gov/reports-and-publications/workplan/index.asp