On November 10, 2016, the Office of Inspector General (“the OIG”) of the U.S. Department of Health and Human Services (“DHHS”) released its 2017 Work Plan. Published annually and updated throughout the year, the Work Plan identifies the OIG’s key areas of focus as it carries out its mission of protecting the integrity of programs within DHHS. The OIG is charged with ensuring the integrity of more than 100 programs administered by DHHS, including those within the Centers for Medicare and Medicaid Services, Center for Disease Control and Prevention, the Food and Drug Administration, and the National Institute of Health. The OIG Work Plan summarizes the OIG’s current activities – comprised of both new and revised activities — along with information regarding previously identified activities that have been completed, postponed, or cancelled.
The Work Plan highlights new and continuing priorities applicable to various provider types, including hospitals, nursing homes, hospices, home health, clinical laboratories, physicians and other health professionals, medical equipment suppliers and manufacturers, pharmaceutical manufacturers and other providers and suppliers.
The 2017 Work Plan is available here.
The following is a sampling of some of the new and ongoing efforts highlighted in the Work Plan:
The Office of Inspector General’s (“OIG”) recent release of OIG Advisory Opinion No. 15-02 is an important reminder that providers must be vigilant in complying with prohibitions against receiving payment for items or services provided by excluded individuals or entities.
Yesterday, the Office of Inspector General (“OIG”) published “Practical Guidance for Health Care Governing Boards on Compliance Oversight.” The guide is intended as an educational resource for the boards of healthcare entities of all sizes and is the result of a unique collaboration between the OIG and a number of private health care trade organizations. Topics covered by the guide include:
- expectation of the board with respect to compliance functions;
- appropriate relationships between audit, compliance, and legal departments within the organization;
- establishing expectations regarding reporting to the board;
- identifying and auditing potential risk areas; and
- encouraging a culture of compliance.
The guide can be found here.
The Medicare and Medicaid Electronic Health Care Record (“EHR”) Incentive Program (commonly referred to as “Meaningful Use”) provides incentive payments to eligible physicians and hospitals for adopting, implementing, upgrading, or demonstrating meaningful use of certified EHR technology. Medicare incentive payments are authorized over a 5-year period (2011 through 2016). As of February 2015, total EHR incentive payments exceeded $29.5 billion.
A laboratory proposing to enter into an exclusive relationship with physician practices has been advised that the arrangement may violate federal law. The laboratory sought advice from the Office of Inspector General (“OIG”) of the Department of Health and Human Services on an arrangement in which the laboratory would contract with physician practices to provide all laboratory services to the practices’ patients, without regard to the patients’ health insurance coverage. The requesting laboratory would not bill those patients whose health plans — so-called “exclusive plans” — require them to use other laboratories (nor would the lab bill the practices themselves). In its Advisory Opinion posted on March 25, 2015, the OIG concluded that the arrangement may violate the Anti-Kickback Statute and subject the laboratory to administrative sanctions, including exclusion from federal health care programs (e.g., Medicare and Medicaid).
Last week, while many of us were digging out from one snowstorm and bracing for another, the United States Department of Health and Human Services (“HHS”) was keeping busy. HHS lawyers were preparing to defend a key regulation under the Affordable Care Act (“ACA”) before the U.S. Supreme Court, and HHS’ Office of Inspector General (“OIG”) released its Health Reform Oversight Plan (“the Oversight Plan”) for the 2015 fiscal year. The OIG is charged with protecting the integrity of HHS programs and the welfare of program beneficiaries. It carries out this mission through a variety of initiatives, including audits, investigations, evaluations and enforcement activities.
The Oversight Plan identifies the OIG’s four key strategic goals in overseeing ACA programs: (1) fighting fraud, waste and abuse; (2) promoting value, safety and quality; (3) securing the future; and (4) advancing excellence and innovation. With these goals in mind, the Oversight Plan highlights two key areas of focus for the OIG: health insurance marketplaces and other ACA-related reforms.Read More