The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently updated its Work Plan, adding several new audits and reviews. The OIG Work Plan forecasts the projects that the OIG plans to implement over the foreseeable future. These new initiatives are a signal of which areas the OIG views as warranting heightened scrutiny, and providers in these areas should take note of the OIG’s actions.
One of the most notable projects on the OIG Work Plan focuses on auditing Medicare claim lines for which the payment exceeds the actual charge. CMS contracts with various Medicare Administrative Contractors (MACs) to, among other things, process and pay claims submitted by providers for items and services covered under Medicare Part B. Generally, Part B payments are based on a fee schedule, prospective payment system, or some other method, rather than a cost or charge basis. In most cases, a healthcare provider’s billed charges exceed the amount that Medicare pays for Part B items and services. Under this Work Plan item, the OIG is focused on Medicare payments that exceed the billed charges, which can be overpayments. Providers should keep a close watch on their Medicare remittance advices or explanation of benefits to be aware of any payments that exceed the corresponding billed charge.
In terms of specific healthcare services, the OIG is turning its attention to hyaluronic acid injections, commonly used to treat knee osteoarthritis. While these injections are widely used for joint pain, there are ongoing questions about whether they are worth the cost and being used appropriately. The OIG’s audit will review Medicare reimbursements for these treatments and whether providers are following proper billing procedures.
Additionally, one Work Plan item will look at how the National Institutes of Health (NIH) is using its Other Transactions Awards. These awards allow the NIH to fund projects that fall outside traditional grants, offering more flexibility to foster innovation. However, with fewer regulations than standard grants, there is a greater chance for funds to be mishandled. The OIG plans to review how these funds are being spent and determine whether such funds are being used properly and in line with federal rules.
Another audit item in the latest Work Plan focuses on healthcare facilities in regions prone to hurricanes, particularly with the 2024 hurricane season approaching. As severe weather becomes more common, it is essential that healthcare providers are prepared to maintain operations during adverse conditions. This audit will assess whether facilities in high-risk areas have adequate plans in place to continue providing care, even under difficult conditions. The findings may influence future policies around disaster preparedness in healthcare.
Lastly, the OIG is looking at the performance of the Office of Refugee Resettlement’s Call Center. As the refugee population grows, this call center has become a vital resource for those seeking help. The audit will evaluate how well the call center is handling calls, especially during times of increased demand. This review will help determine if the center is equipped to meet the needs of refugees efficiently and effectively.
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, Medicare audits, or healthcare compliance, please contact an experienced healthcare attorney at 248-544-0888 or wapc@wachler.com.