The Department of Health and Human Services (HHS) Office of Inspector General (OIG) announced several new changes in its Work Plan update in August 2022. The OIG Work Plan forecasts the projects that OIG plans to implement over the foreseeable future. These projects usually include OIG audits and evaluations. Below are the highlights from the Work Plan update of which providers and suppliers should take notice.
First, OIG will perform an audit of selected HHS divisions to evaluate the effectiveness of security controls to determine whether service providers are identifying and reporting cybersecurity events. The audit seeks to ensure HHS’s compliance with the Federal Information Security Management Act and OMB Circular A-130 which requires Federal agencies to ensure that service providers meet the security requirements for transmitting, processing, or storing Federal information.
Second, OIG will perform a nationwide review of skilled nursing facility (SNF) costs for services, facilities, and supplies furnished by entities with common ownership with the SNF. Medicare regulations require that the cost of services, facilities, and supplies furnished to a provider by an organization under common ownership or control be the same or lower than the cost of comparable services and supplies purchased elsewhere. Accordingly, the review will compare these costs to determine whether skilled nursing facilities are reporting these related-party costs in accordance with the Medicare regulations. The review will also consider how a skilled nursing facility’s allocation of Medicare funds can impact beneficiary care.
Third, OIG will conduct a nationwide audit to identify areas for improvement in CMS’s emergency preparedness for clinical laboratories. Despite adopting the Emergency Preparedness Rule in September 2016, the rule does not apply to clinical laboratories. OIG acknowledged the importance of laboratory testing for identifying the spread of novel infectious diseases (including COVID-19) and intends to determine whether clinical laboratory emergency preparedness could be improved. The review will assess CMS’s emergency preparedness to ensure that beneficiaries maintain access to all types of laboratory testing during public health emergencies and that the laboratories are able to develop and deliver accurate and timely testing for novel diseases.
Fourth, OIG, in coordination with the Pandemic Response Accountability Committee (PRAC), will produce a report to identify shortages in health care personnel in Federal, health-related programs that are overseen by Federal agencies. This report will be made in response to PRAC’s identification of health care personnel as critical Federal Government resources in COVID-19 response efforts. OIG will focus its review on personnel shortages in nursing homes and will outline best practices for hiring and retaining health care personnel.
Fifth, OIG will analyze Medicare laboratory test expenditures for the 2021 year and publicly release its findings for the top 25 laboratory test expenditures for the year. The report will be released under the requirements outlined in the Protecting Access to Medicare Act of 2014 (PAMA). PAMA requires CMS to fix payment rates for laboratory tests according to current charges in the private health care market, and also requires the public release of the report.
Finally, OIG will review the States’ Medicaid eligibility and enrollment actions at the end of the COVID-19 public health emergency (PHE). The Families First Coronavirus Response Act (FFCRA) provided qualifying States with a temporary increase of 6.2 percentage points to their Federal Medical Assistance Percentage (FMAP). The increased FMAP was contingent on the States providing benefits to individuals enrolled in Medicaid at the beginning of the COVID-19 PHE or who became enrolled during the PHE. CMS requires that the States must initiate all renewals, post-enrollment verifications, and redeterminations for all individuals enrolled during the PHE and will assess whether the States complied with the CMS requirements by completing pending Medicaid Eligibility and enrollment actions.
For over 35 years, Wachler & Associates has represented healthcare providers and suppliers nationwide in a variety of health law matters, and our attorneys can assist providers and suppliers in understanding new developments in healthcare law and regulation. If you or your healthcare entity has any questions pertaining to OIG reviews or healthcare compliance, please contact an experienced healthcare attorney at 248-544-0888 or firstname.lastname@example.org.