OIG's 2014 Work Plan Released

Nancy Leveille and Karen Morris in Clinical & Quality


Dianne De La Mare, AHCA, notified NYSHFA that the US Department of Health and Human Services, Office of Inspector General (OIG) has just released its Work Plan for FY 2014, which summarizes new and ongoing OIG reviews and activities for 2014.  Usually released each year in October, but delayed this year, the Work Plan helps LTC providers to focus on the issues most critical to the federal government.  Under the heading, Nursing Facilities, OIG’s Work Plan focuses on Medicare Part A billing by skilled nursing facilities (SNFs); Questionable billing practices for Part B services during nursing home stays; State agency verification of deficiency corrections; Program for national background checks for long term care employees; and Hospitalizations of nursing home residents for manageable and preventable conditions.  Under the heading, Hospices, the Work Plan focuses on Hospice in assisted living facilities.  Under the heading, Part A and Part B Contractors, the Work Plan focuses on Medicare administrative contractors—use and evaluation of local edits; Medicare benefit integrity contractors’ activities; and ZPICs and PSCs—identification and collection status of Medicare overpayments.  Under the heading Other Part A and Part B Program Management Issues, the Work Plan focuses on Payments for incarcerated beneficiaries; Enhanced enrollment screening process for Medicare providers; Idle Medicare provider records; and Payments to providers subject to debt collection.  Under the heading, Medicare Advantage, the Work Plan focuses on Encounter data—CMS oversight of data integrity; and Risk adjustment data—sufficiency of documentation supporting diagnosis.  Under the heading, State Management of Medicaid, the Work Plan focuses on State mechanisms to fund their Medicaid Programs; State claims for federal reimbursement; State adjustments of federal reimbursement; State program integrity activities and compliance with federal requirements; and OIG oversight of state Medicaid Fraud Control Units.  Under the heading, Medicaid Managed Care, the Work Plan focuses on State payments to managed care entities; data collection and reporting; program integrity in managed care; and beneficiary protections in managed care.  Under the heading Legal Activities, the Work Plan focuses on Exclusions from program participation, Civil monetary penalties; False Claims Act cases and corporate integrity agreements; Providers’ compliance with corporate integrity agreement; Advisory opinions and other industry guidance; and Provider compliance training and provider self-disclosure.  To obtain a complete copy of OIGs work plan go to http://oig.hhs.gov/reports-and-publications/workplan/index.asp#current/.

  NYSHFA CONTACTS: Nancy Leveille, RN, MS
Sr. Director, Member Operational Support
518-462-4800 x20
  Karen Morris, RN, MS
Director, Clinical & Quality Services
518-462-4800 x15