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OIG Releases Fiscal Year 2012 Work Plan

Today, the Office of Inspector General (OIG) released the fiscal year 2012 Work Plan. The plan describes the activities the OIG plans to continue, as well as activities it plans to initiate. The 2012 fiscal year, and the programs described, runs from October 1, 2011 through September 30, 2012. Below is a list of several new and continuing OIG activities for various health care providers.

Home Health Services (New)

  • States’ Survey and Certification of Home Health Agencies: Timeliness, Outcomes, follow-up, and Medicare Oversight
  • Missing or Incorrect Patient Outcome and Assessment Data
  • Questionable Billing Characteristics of Home Health Services
  • Medicare Administrative Contractors’ Oversight of Home Health Agency Claims
  • Wage Indexes Used To Calculate Home Health Payments

Home Health Services (Continued)

  • Medicare’s Oversight of Home Health Agencies’ Patient Outcome and Assessment Data
  • Home Health Agency Claims’ Compliance With Coverage and Coding Requirements
  • Home Health Prospective Payment System Requirements
  • Home Health Agency Trends in Revenues and Expenses

Hospitals (New)

  • Accuracy of Present-on-Admission Indicators Submitted on Medicare Claims
  • Medicare Inpatient and Outpatient Payments to Acute Care Hospitals
  • Acute-Care Hospital Inpatient Transfers to Inpatient Hospice Care
  • Medicare Outpatient Dental Claims
  • In-Patient Rehabilitation Facilities

Hospitals (Continued)

  • Hospital Reporting for Adverse Events
  • Reliability of Hospital-Reported Quality Measure Data
  • Hospital Admissions With Conditions Coded Present on Admission
  • Hospital Inpatient Outlier Payments: Trends and Hospital Characteristics
  • Medicare’s Reconciliations of Outlier Payments
  • Hospital Claims With High or Excessive Payments
  • Hospital Same-Day Readmissions
  • Medicare Payments for Beneficiaries With Other Insurance Coverage

Nursing Homes (new)

  • Safety and Quality of Post-Acute Care for Medicare Beneficiaries
  • Nursing Home Compliance Plans
  • Questionable Billing Patterns During Non-Part A Nursing Home Stays

Nursing Homes (Continued)

  • Medicare Requirements for Quality of Care in Skilled Nursing Facilities
  • Oversight of Poorly Performing Nursing Homes
  • Nursing Home Emergency Preparedness and Evacuations During Selected
  • Hospitalizations and Rehospitalizations of Nursing Home Residents

Hospices (New)

  • Hospice Marketing Practices and Financial Relationships with Nursing Facilities

Hospices (Continued)

  • Medicare Hospice General Inpatient Care

Medical Equipment and Supplies (New)

  • Effectiveness of Edits To Prevent Payments to Multiple Suppliers of Home Blood-Glucose Testing Supplies
  • Collection of Surety Bonds for Overpayments Made to Suppliers of Durable Medical Equipment
  • Support Surface Pricing
  • Questionable Billing for Medicare Diabetic Testing Supplies

Medical Equipment and Supplies (Continued)

  • Medicare Enrollment and Monitoring for Suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
  • Medicare Qualifications of Orthotists and Prosthetists
  • Medicare Supplier Acquisition Costs for Back Orthoses
  • Medicare Payments for Various Categories of Durable Medical Equipment
  • Competitive Bidding Process for Medical Equipment and Supplies
  • Medicare DMEPOS Competitive Bidding Program: Supplier Solicitation of Physician

If you have any questions regarding the OIG’s fiscal year 2012 Work Plan, or any other health law questions, please contact a Wachler & Associates attorney at 248-544-0888.