Industry News

OIG Adds Eleven New Work Plan Items for April.

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently added eleven updates to its Active Work Plan (Work Plan) for April.  The Work Plan outlines ongoing and planned audits and evaluations for the fiscal year and beyond.  In 2017, the OIG began releasing its Work Plan projects on an ongoing basis, as opposed to providing biannual updates.  A monthly update schedule ensures that the Work Plan closely aligns with the OIG’s work planning process.  The OIG considers several factors when creating Work Plan items, including legal mandates, congressional requests, budgetary concerns, potential for positive impact, and others.  In addition to working on projects that often lead to audits, reviews, and reports, the OIG also engages in a number of legal and investigative activities that are separately reported.

The April additions to the OIG Work Plan include the following:

  1. Access Increases in Mental Health and Substance Abuse Services Funding for Health Centers

The Office of Audit Services (OAS) will conduct a study to determine whether the Health Resources and Services Administration’s (HRSA) award of $200 million in Access Increases in Mental Health and Substance Abuse Services (AIMS) supplemental funding was used in accordance with federal requirements and grant terms.

  1. Quality of Medicaid Encounter Data

The Office of Evaluation and Inspections (OEI) will study three to five states’ Transformed Medicaid Statistical Information System (T-MSIS) encounter data to determine whether the encounter data contains the required elements and quality data needed to oversee the Medicaid program

  1. Sufficiency and Implementation of Indian Health Service (IHS) Patient Abuse Policies

The OEI will conduct a study to evaluate the sufficiency and implementation of new IHS policies and procedures related to patient abuse.

  1. Review of State Uncompensated Care Pools (UCP)

The OAS will review whether selected states’ Medicaid agencies made payments to hospitals under the UCPs in accordance with the Centers for Medicare & Medicaid Services (CMS) special terms and conditions of the waiver and federal regulatory requirements.

  1. Deficiencies in a State Foster Care System

The OAS will review whether foster care group homes were in compliance with criminal background check and health and safety requirements, as well as whether the states’ oversight process ensured compliance with licensing requirements.

  1. Audit of National Institutes of Health Information Technology and Interoperability Challenges Within Its Electronic Health Record (EHR) System

The OAS will review select EHR system controls to determine whether they meet federal requirements and assess EHR interoperability challenges.

  1. Projects for Assistance in Transition from Homelessness (PATH) Program

The OAS will review states that received PATH program grants from the Substance Abuse and Mental Health Services Administration (SAMHSA), the Department of Health and Human Services’ (HHS) agency tasked with administration and oversight of the PATH program, to determine whether some recipients were in compliance with federal requirements in providing PATH program services.

  1. Medicaid Managed Care Organization (MCO) Denials

The OAS will review Medicaid MCO denials to determine whether they were in compliance with federal requirements when denying requested medical services, dental services, and drug prescriptions that required prior authorizations.

  1. Review of Monthly End Stage Renal Disease (ESRD)-Related Visits Billed by Physicians or Other Qualified Healthcare Professionals

The OAS will review monthly ESRD-related visits that physicians or other qualified healthcare professionals billed to determine whether they were in compliance with federal requirements.

  1. Medicaid Personal Care Services (PCS)

The OAS will determine whether states have made improvements to the oversight and monitoring of PCS to reduce significant problems identified in prior OIG reviews regarding states’ compliance with PCS requirements.  In addition, the OAS will determine whether those improvements have reduced noncompliant PCS claims.

  1. Case Study: Closure of the Rosebud Hospital Emergency Department

The OEI, in response to concerns about the closure of the Rosebud Hospital emergency department and termination of the Rosebud hospital from the Medicare program, will examine the Indian Health Service’s decision-making process that resulted in such a determination.

The OIG Work Plan is available at: