OIG Makes Multiple Updates to Work Plan in May 2021

In May 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 that OIG plans to address during the fiscal year and beyond. These are some of the highlights of the new additions to the work plan of which providers and suppliers should be aware.

First, OIG will audit payments made to healthcare providers under the general distributions of the Provider Relief Fund. This includes approximately $92 billion across all three phases of the general distributions. Provider who received these funds were required to meet certain requirements, such as submitting revenue information and supporting documentation to the Health Resources and Services Administration (HRSA), which used this information to determine eligibility and payments. OIG will perform a series of audits of funds related to the three phases of the General Distribution to determine whether payments were: (1) correctly calculated for providers that applied for these payments, (2) supported by appropriate and reasonable documentation, and (3) made to eligible providers.

Second, OIG will conduct a nationwide, three-part study of the effects of the COVID-19 pandemic on nursing homes. The first part will analyze the extent to which Medicare beneficiaries residing in nursing homes were diagnosed with COVID-19 and describe the characteristics of those who were at greater risk. The second part will describe the characteristics of the nursing homes that were hardest hit by the pandemic (i.e., homes with high numbers of beneficiaries who had COVID-19). The third part will describe the strategies nursing homes used to mitigate the unprecedented challenges of COVID-19.

Third, OIG announced two new areas where it will focus its audit efforts. OIG will conduct audits of Medicare payments for spinal pain management services, including facet joint injections, facet joint denervation sessions, lumbar epidural injections, and trigger point injections. Additionally, OIG will conduct audits to determine whether new hospitals (those in their first two years of operation) claimed Medicare-related capital costs in accordance with Federal regulations.

Fourth, OIG will determine how the hospital transfer policy for early discharges to post-acute care (PAC) would financially affect Medicare and hospitals if it were expanded to include all Medicare Severity Diagnosis-Related Groups (MS-DRGs). OIG has indicated that analysis of Medicare claims data demonstrates significant occurrences of early discharges from hospitals to PAC facilities for MS-DRGs that are not currently subject to the PAC transfer payment policy. OIG seeks to provide CMS with a more updated analysis of the financial impact that an expanded hospital-to-PAC transfer payment policy (i.e., all MS-DRGs) would have on Medicare and hospitals.

Finally, OIG announced that it will review the impact of the COVID-19 pandemic on state child support enforcement operations and will also review National Institute of Health (NIH) research grants to foreign recipients.

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