Recently, the Office of Inspector General of the United States Department of Health and Human Services (“OIG”) released its Fiscal Year 2015 Work Plan summarizing its oversight and enforcement priorities for the 2015 Fiscal Year. Here are some highlights from the Work Plan.

Hospital-Related Policies and Practices

• OIG will determine the impact of new inpatient admission criteria on hospital billing, Medicare payments, and beneficiary copayments. OIG will specifically examine hospital inpatient claims for compliance with the “two midnight policy”.

• OIG will review data from Medicare cost reports and hospitals to identify salary amounts included in operating costs reported to and reimbursed by Medicare. Employee compensation may be included in allowable provider costs only to the extent that it represents reasonable compensation for managerial, administrative, professional and other services related to the operation of the facility and furnished in connection with patient care.

• OIG will provide greater Medicare oversight of facilities claiming provider-based status to determine the extent to which provider-based facilities meet CMS’s regulatory criteria.

• OIG will provide greater oversight of hospital privileging by determining how hospitals assess medical staff candidates before granting initial clinical privileges, including verification of credentialing and review of the National Practitioner Databank.

Hospices

OIG will review the use of hospice general inpatient care and will assess the appropriateness of hospices’ general inpatient care claims and the content of election statements for hospice beneficiaries who receive general inpatient care. OIG also plans to review hospice medical records to address concerns that this level of hospice care is being misused.

Ambulance Services

OIG will examine Medicare claims data to assess the extent of questionable billing for ambulance services, such as transports that never occurred or potentially were medically unnecessary transports to dialysis facilities.

Sleep Disorder Clinics

OIG will examine Medicare payments to physicians, hospital outpatient departments, and independent diagnostic testing facilities for sleep-testing procedures to assess the appropriateness of Medicare payments for high-use sleep-testing procedures and determine whether they were in compliance with Medicare requirements.

Provider Eligibility

OIG will determine the extent to which and the way in which CMS and its contractors have implemented enhanced screening procedures for Medicare providers pursuant to Section 6401 of the Affordable Care Act. CMS is implementing new authorities that include site visits, fingerprinting, and background checks, as well as an automated screening process.

Adult Day Health Care Services

OIG will review Medicaid payments by States for adult day care services to determine whether providers complied with Federal and State requirements.

Health care providers should review their compliance policies and procedures in light of the Work Plan and identify any compliance vulnerabilities. The full Work Plan can be found on the OIG website, hhh.oig.gov.