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OIG Releases 2004 Work Plan
December 11, 2003

The work plan of the Office of Inspector General (OIG) has been posted to the Department of Health and Human Services (DHHS) web site, outlining the projects to be addressed during fiscal year 2004. OIG is charged with improving DHHS programs and operations by protecting them against fraud, waste, and abuse. PCPA has identified several of OIG’s identified projects that may impact its members and has generated a list of these projects, as well as a short explanation of each. The entire work plan is available by going to the following web site: www.oig.hhs.gov/publications/workplan.html#1.

Medicare

  • Medical Necessity of Inpatient Psychiatric Stays
    • To determine the extent that any improper Medicare payments for inpatient psychiatric stays were due to medical necessity or coverage issues.
  • Coding of Evaluation and Management Services
    • To examine coding of evaluation and management services.
  • Services and Supplies Incident to Physicians’ Services
    • To evaluate the conditions under which physicians bill “incident-to” services and supplies. “Incident=to services… must be provided by an employee of the physician under the physician’s direct supervision. Because little information is available on these types of services being billed, questions persist about the quality and appropriateness of these billings.”

Medicaid

  • Medicaid Payments for Medicare-Covered Services
    • To determine whether Medicaid paid for any services covered and paid for by Medicare
  • Claims for Residents of Institutions for Mental Diseases
    • To determine whether States improperly claimed Federal Medicaid funds for 21-64-year-old residents of private and county institutions for mental diseases.
  • Administrative Costs of Medicaid Managed Care Organizations
    • To determine whether administrative costs incurred by Medicaid MCOs were reasonable, necessary, and allocable.

HIPAA

  • Compliance with the Health Insurance Portability and Accountability Act - Managed Care Organizations
    • To evaluate an MCO’s general and application controls over electronic transmission of patient data to determine compliance with HIPAA security requirements.

General

  • Provider Overpayments (Medicare)
    • To assess the controls in place at the Medicare contractors and determine whether adequate recovery action was taken on identified provider overpayments.
  • Provider Self-Disclosure
    • To encourage health care providers to promptly self-disclose improper conduct that threatens Federal health care programs, including Medicare and Medicaid.

Contact Rebecca May Cole at the Association with questions.

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