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  • Washington Highlights

    HHS Inspector General Releases Annual Report on Medicare and Medicaid Oversight Work Plan

    Len Marquez, Senior Director, Government Relations

    The Department of Health and Human Services (HHS) Office of Inspector General (OIG) November 10 released its work plan for fiscal year (FY) 2017. The work plan includes current and new projects that OIG will undertake in the coming year.  The OIG will focus its Medicare oversight efforts on identifying and offering recommendations to reduce improper payments, prevent and deter fraud, and foster economical payment policies.

    New projects for FY 2017 include reviews of:

    • The Two-Midnight rule’s impact on hospitals’ use of outpatient and inpatient stays, and the extent to which the use of outpatient and inpatient stays varied among hospitals;

    • Medicare payments for physician office visits in provider-based clinics and freestanding clinics to determine the difference in payments made to clinics for similar procedures;

    • Determining whether hospitals received duplicate or excessive DGME payments and if duplicate payments were appropriate;

    • Determining whether hospitals’ IME payments were calculated properly and made in accordance with Federal requirements;

    • Potential savings if Medicare Part B received Medicaid rebates on prescription drugs to reduce the costs of drugs to the program;

    • Potential savings if pharmaceutical manufacturers paid rebates for Medicare Part D drugs dispensed at 340B covered entities and contract pharmacies; and

    • CMS’s oversight of state Medicaid Section 1115 waivers to examine costs associated with the waivers.