Every year the Office of Inspector General (“OIG”) releases its work plan for the following year, in which it outlines new and current initiatives for investigating and auditing programs under the umbrella of the Department of Health and Human Services. On October 31, 2014, the OIG released its Work Plan for Fiscal Year 2015 (“Work Plan”), outlining 19 new initiatives and carrying over many initiatives from previous work plans. Now that 2015 has begun, hospitals should expect the OIG to begin implementing some of the initiatives discussed in the Work Plan, especially considering the OIG’s touting of the nearly $834.7 million in audit receivables and approximately $4.1 billion in investigative receivables recovered in 2014.
Of the 19 new initiatives identified in the Work Plan, 2 deal directly with hospital quality of care and billing issues. The first is that the OIG will review hospital controls over the reporting of wages used to calculate wage indexes for Medicare payments. According to the OIG, its previous review of the wage index revealed hundreds of millions of dollars in incorrectly reported wage data. The second is that the OIG plans to estimate the number of adverse events occurring in long-term-care hospitals, which represent the third most common type of post-acute care facility after skilled nursing facilities and inpatient rehabilitation facilities.
One of the most notable initiatives that carried over from the 2014 Work Plan is the OIG’s review of the two-midnight rule’s effect on hospital billing, Medicare payments, and beneficiary copayments. As hospitals already know, the two-midnight rule requires that beneficiaries be admitted as outpatients if their expected length of stay does not exceed two midnights. Many hospitals have expected this rule, which was implemented in March of 2014, to decrease the amount of inpatient admissions and thus decrease the amount of Medicare payments—the opposite effect forecasted by the Centers for Medicare and Medicaid Services. The issuance of the OIG’s review of the two-midnight rule is not expected until 2016, and should include a discussion of how billing varied among hospitals in 2014.
Some of the other notable initiatives that carried over from previous work plans include, but are not limited to, the following:
Hospitals should be aware of the OIG’s upcoming initiatives and take proactive steps to stay ahead of the OIG so to avoid overpayment liability and fraud investigations. If you have any questions about the Work Plan and how it may affect your facility, please contact Larry McCarty at email@example.com or Jeff Moore at firstname.lastname@example.org.