The Department of Health and Human Services (HHS) Office of Inspector General (OIG) June 7 released its mid-year update of its work plan for fiscal year (FY) 2016. The work plan, last updated October 2015, includes current and new projects that OIG will undertake in the coming year. The OIG continues to focus its Medicare oversight efforts on identifying and offering recommendations to reduce improper payments, prevent and deter fraud, and foster economical payment policies.
Among the new projects for FY 2016 are:
A review of potential savings if hospital outpatient stays were ineligible for an outlier payment;
A review of compliance with the skilled nursing facility (SNF) prospective payment system related to the requirement that a beneficiary be an inpatient for at least three consecutive days before discharge; and
A review of the Medicare Shared Savings Program (MSSP) to determine whether CMS properly assigned beneficiaries to accountable care organizations (ACOs) and ensure there is no duplication of payments for those beneficiaries by other savings programs or initiatives.
The mid-year plan also includes studies of medical research programs at the National Institutes of Health (NIH) and other HHS agencies. Among the listed projects is an assessment of academic institutions’ control over the subcontracting on NIH grants and contracts. The OIG plan states, “We will determine whether colleges and universities effectively monitor the services subcontracted to other organizations and ensure that Federal funds are spent on allowable goods and services in compliance with selected cost principles and the terms and conditions [of award].”
The OIG notes they conduct the review of “selected organizations” based on input from NIH and the volume of federally sponsored research performed by the organizations.