OIG Publishes 2016 Work Plan

Health Law Alert

November 24, 2015
Health Law Alert

Each November, the U.S. Department of Health and Human Services Office of Inspector General (“OIG”) publishes its Work Plan for the coming fiscal year. The Work Plan describes OIG’s new and ongoing audit and enforcement priorities for the upcoming year and gives providers of health care insight into assessing what the OIG believes may be problematic and systemic weaknesses in the Medicare and Medicaid system. A thorough review of the Work Plan is helpful in identifying compliance risk areas and giving providers the ability to determine those compliance program activities and audits that need to occur.

The Work Plan published in early November applies to Medicare Part A and B, and Medicare Part C and D, as well as the Medicaid Program. Entities covered by the Work Plan include hospitals, nursing homes, hospices, home health services, medical equipment suppliers and other providers. The Work Plan can be found here

The Work Plan includes several interesting statistics reflecting the enforcement activities of the OIG:

With the number of potential investigations, and the dollars involved, providers are well advised to review the Work Plan to determine those issues that the OIG has indicated are important to it.

Among the Work Plan elements that are of particular significance to hospitals are the following:

With regard to nursing homes, the OIG will review, among other matters, the following:

Other providers should note the OIG will review:

There are a number of equipment and supplies initiatives underway for policies and practices, and billing and payment. A few of those are as follows:

Health care providers should review the 2016 Work Plan to determine which of the government’s initiatives might affect them. Those initiatives should be given priority in any compliance efforts for Fiscal Year 2016. Health care organizations should, at least on an annual basis, review their compliance program to add elements of the Work Plan that may affect them. The elements of the Work Plan that may affect the provider should form the basis of any new or revised written policies and procedures that the health care provider may need to implement. Those revised policies and procedures should be done after there has been an assessment of the health care organization’s compliance risks, an evaluation of the current compliance program’s ability to mitigate those risks, and any revisions to current policies and procedures in order to best ensure compliance with those risks.

The above elements are necessary for an effective compliance program which demonstrates a good faith effort to comply with applicable statutes, regulations and other federal health care program requirements. This activity may significantly reduce the risk of unlawful conduct and potential sanctions.

For further information please contact your regular Hinshaw attorney or Roy M. Bossen.