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OIG’s 2016 Work Plan Means Further Scrutiny for Hospitals

Focus is on cutting costs and avoiding duplicate payments

A new federal work plan shows a growing shift in the priorities of the Department of Health and Human Services’ (HHS) Office of Inspector General (OIG), particularly with regard to hospitals, according to a report from FierceHealthcare.

Instead of new hospital projects, the OIG will aim to complete in 2016 those already in progress, Sara Lord, an attorney with the Georgia law firm Arnall Golden Gregory, said in a published analysis. Lord used to work for the HHS.

In the next fiscal year, the OIG will sharpen its focus on reforming health care delivery and improving alternative-care models and value-based purchasing, with an emphasis on cutting health care costs and avoiding duplicate payments.

The only new hospital projects announced in the work plan are payment-focused, including a review of Medicare payments to acute care hospitals and an analysis of the Centers for Medicare & Medicaid Services’ validation of inpatient quality-reporting data. The plan also increases the focus on fraud and abuse detection within Medicare Part D and drug reimbursement.

Most projects included in the plan build on previous plans, with several focusing specifically on outcomes and care quality, including:

  • Developing an estimate for national rates of adverse and temporary harm events involving Medicare patients receiving post-acute care at rehabilitation centers
  • Developing similar estimates of harm events in long-term care hospitals as well as contributing factors and associated costs
  • Assessing hospitals’ readiness for high-risk infectious diseases, in keeping with the OIG’s previous analysis of threats, such as pandemics and national disaster preparedness

“While the relative lack of new hospital-focused projects is interesting, it is also clear that the OIG will complete and publish a considerable number of reports concerning hospitals in 2016,” Lord said. “Since the OIG’s findings in these reports often furnish the bases for further government investigation, hospitals should prepare for, and expect, continuing scrutiny in these areas.”

Sources: FierceHealthcare; November 18, 2015; and HHS; November 2015.

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