In late 2016, the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) released its 2017 Work Plan. The plan lists the topics in which it sees the greatest potential for fraud under federal health care programs, primarily Medicare and Medicaid. The OIG updates its Work Plan throughout the year as conditions warrant.
The plan is extensive, and for that reason we are presenting the information in several topical parts.
We are wrapping up our series with Part IV and a focus on some of the OIG’s Medicaid-related concerns, along with two points regarding electronic health records.
As mentioned in Part III, because the federal government provides significant funding to State-run Medicaid programs, OIG maintains a significant role in protecting the program from fraud, waste, and abuse. In addition to concerns regarding prescription drugs, OIG has flagged the following, among other areas, for review during FY2017:
- Medicaid Personal Care Services (PCS) are an ongoing area of concern for OIG and they continue to track federal and state investigations, indictments, convictions, and recoveries involving fraud and patient abuse or neglect.
- Beneficiaries enrolled in adult day health care programs must meet eligibility requirements and services must be furnished in accordance with a plan of care. OIG is reviewing Medicaid payments under the program for compliance with federal and state requirements.
- OIG will review transfer rates of Medicaid beneficiaries from group homes and nursing facilities to hospital emergency rooms, with high transfer rates raising concerns about quality of care.
- The Work Plan cites Medicaid payments to Medicaid managed care organizations (MCOs) for services taking place after the beneficiaries’ dates of death as an area for investigation.
- OIG will determine whether MCOs are identifying and addressing incidents of fraud, waste, and abuse and the processes they have in place to detect and investigate same.
Electronic Health Records
The Health Information Technology for Economic and Clinical Health Act (HITECH) created incentive programs under both Medicare and Medicaid to promote the adoption of electronic health records (EHR) by providers. Incentive payments are made to providers that attest to “meaningful use” of EHRs. The General Accounting Office has identified improper incentive payments as the primary risk to the incentive program. OIG noted two areas of particular concern:
- Incentive payments to eligible health care professionals and hospitals for adopting EHRs will be reviewed for erroneous incentive payments (i.e. not meeting meaningful-use criteria).
- Protection of health information is a core meaningful-use metric that is measured via a security risk analysis of certified HER technology. OIG will perform audits of covered entities to determine whether they have adequately protected electronic health information.
This concludes our four-part series on the OIG’s FY2017 Work Plan. Should you have questions regarding Part IV or any other parts of our series, please do not hesitate to contact any of the FisherBroyles Health and Pharmacy Law attorneys listed below.
Brian E. Dickerson
Nicole Hughes Waid