OIG Work Plan Includes HCBS Investigations
Medicare and Medicaid payments remain high on the list of the US Department of Health and Human Services Office of Inspector General (HHS/OIG) priorities in its 2017 Work Plan. The Work Plan summarizes new and ongoing reviews and activities that the OIG plans to pursue with respect to HHS programs and operations during the current fiscal year. The amount of work conducted about particular programs is determined by the amount of funds available and the purpose limitations in the funding appropriated to OIG. OIG’s funding that is directed toward oversight of the Medicare and Medicaid programs—including oversight of financial integrity and quality and safety of medical services—constitutes a significant portion of OIG’s total funding (approximately 78 percent in FY 2016).
OIG listed several planned activities directly related to “Home Health Services and Other Community-Based Care:”
Data Brief on Fraud in Medicaid Personal Care Services OIG plans to issue a data brief that provides, through data collected from the 50 State Medicaid Fraud Control Units (MFCUs) and OIG’s Office of Investigations, an overview of PCS statistical data. The data brief will provide information on State and Federal investigations, indictments, convictions, and recoveries involving fraud and patient abuse or neglect in Medicaid PCS. The data that will be presented in this brief “are intended to illustrate the prevalence and magnitude of fraud and patient abuse or neglect involving PCS.”
Oversight and Effectiveness of Medicaid Waivers According to OIG, “oversight of State waiver programs present challenges to ensure that payments made under the waivers are consistent with regards to efficiency, economy, and quality of care and do not inflate Federal costs.” OIG “will determine the extent to which selected States made use of Medicaid waivers and if costs associated with the waivers are efficient, economic, and do not inflate Federal costs,” and expects to issue a report in 2018.
Adult Day Health Care Services Prior OIG work shows that adult day health care services “payments do not always comply with Federal and State requirements.” OIG plans to “review Medicaid payments by States for adult day health care services to determine whether providers complied with Federal and State requirements.”
Room-and-Board Costs Associated with HCBS Waiver Program Payments OIG plans to investigate “whether selected States claimed Federal reimbursement for unallowable room-and-board costs associated with services provided under the terms and conditions of HCBS waiver programs, and “determine whether HCBS payments included the costs of room and board and identify the methods the States used to determine the amounts paid.”