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OIG Work Plan Monthly Review: April 2018

Four of the six new items that the OIG added to its workplan have an impact—albeit indirect—on labs:

1. CMS Recovery of Medicare Overpayments

Issue: Between Oct. 1, 2014 and Dec. 31, 2016, OIG issued 153 Medicare audit reports listing 193 monetary recommendations. Of the $648 million in overpayment recoveries that OIG recommended, CMS agreed to collect $566 million.

OIG Action: The OIG plans to determine how much of that money CMS collected and whether it took the corrective actions the OIG recommended with regard to its systems and procedures for recording, collecting and reporting overpayments and instructing Medicare contractors on how to document overpayment collections.

2. Mandatory Review of Rules on Dual-Eligible Beneficiary Access to Drugs Under Part D

Issue: Dual-eligible beneficiaries who are enrolled in Medicaid also qualify for Medicare Part D prescription drug coverage. Part D plan sponsors have the discretion to include different Part D drugs and drug utilization tools in their formularies as long as the plan meets certain limitations.

OIG Action: As required by the Affordable Care Act, the OIG will perform an annual review to determine the extent to which drug formularies developed by Part D sponsors include drugs commonly used by dual-eligible beneficiaries as required.

3. Personal Use of Government Email by HHS Officials

Issue: Misuse of personal emails by government officials has become a controversial issue of late and Congress has now asked the OIG to conduct a review of internal policies and practices at HHS.

OIG Action: The OIG will determine whether HHS and its operating divisions have controls in place to:

  • Ensure officials’ use of email is restricted to government business in accordance with federal laws and regulations; and
  • Preserve all emails related to government activities.

4. Medicaid Nursing Home Supplemental Payments

Issue: CMS makes supplemental payments to nursing homes covering the difference between Medicare and Medicaid rates for nursing home services in some states. Under some of these programs, local governments fund the states’ share of the supplemental payments through intergovernmental transfers.

OIG Action: OIG will review the nursing home supplemental payment program’s flow of funding and determine how the funds are being used bearing in mind the fact that previous OIG and GAO audits have found that federal supplemental payments often benefit the state and local governments more than the nursing homes.

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