OIG Makes Multiple Updates to Work Plan in January 2021

In January 2021, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) added several new items to its work plan. The OIG work plan sets forth various projects including OIG audits and evaluations that are underway or planned to be addressed during the fiscal year and beyond by OIG. These are some of the highlights of the new additions to the work plan of which providers and suppliers should be aware.

First, due to increased use of telehealth during the COVID-19 public health emergency, OIG will conduct a series of audits of Medicare Part B telehealth services in two phases. Phase one audits will focus on making an early assessment of whether services such as evaluation and management, opioid use order, end-stage renal disease, and psychotherapy meet Medicare requirements. Phase two audits will include additional audits of Medicare Part B telehealth services related to distant and originating site locations, virtual check-in services, electronic visits, remote patient monitoring, use of telehealth technology, and annual wellness visits to determine whether Medicare requirements are met.

OIG will also evaluate home health services provided during the COVID-19 public health emergency to determine which types of skilled services were furnished via telehealth, and whether those services were administered and billed in accordance with Medicare requirements. OIG has indicated that it will report as overpayments any services that were improperly billed and will make appropriate recommendations to CMS based on the results of our review.

Second, OIG will review whether the Health Resources and Services Administration (HRSA) used an effective process for identifying and monitoring high-risk health centers that received COVID-19 grant funds. HRSA had awarded nearly $2 billion to approximately 1,380 health centers in response to the COVID-19 pandemic. Instead of requiring applications, HRSA made the fund available immediately and required health centers to submit documentation for approval after the fact. Although not a direct audit of the health centers, OIG’s review of HRSA will likely involve review of some health centers’ compliance with these documentation requirements.

Third, in a continuation of OIG’s enforcement in the area of orthotic braces and other durable medical equipment (DME), OIG will compile the results of prior OIG audits, evaluations, and investigations of orthotic braces that were paid for by Medicare. OIG will then analyze this data to identify trends in payment, compliance, and fraud vulnerabilities, and offer recommendations for improving detected vulnerabilities.

Fourth, OIG expressed concern that Medicare Part D may be improperly paying for prescription drugs related to posthospital SNF care that are already included in the consolidated payment for Part A SNF stays. OIG will therefore review whether Medicare Part D paid for drugs that should have been paid under Part A SNF stays.

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 responding to audits and understanding new developments in healthcare law and regulation. If you or your healthcare entity has any questions pertaining to healthcare compliance, please contact an experienced healthcare attorney  at 248-544-0888 or wapc@wachler.com