Each month, we are pleased to share the most recent additions to the HHS Office of Inspector General (OIG) Work Plan items. Starting in June 2017 – OIG has been updating their Work Plan monthly with any new changes to the active list. Let’s take a look at the new updates from this month.

April’s agenda includes 10 new items from HHS Office of Inspector General (OIG). Let’s walk through some of the latest releases so you can address each item within your compliance program, if applicable.

  1. Access Increases in Mental Health and Substance Abuse Services Funding for Health Centers
  2. Quality of Medicaid Encounter Data
  3. Medicaid Managed Care Organization Denials
  4. Deficiencies in a State Foster Care System
  5. Audit of National Institutes of Health Information Technology and Interoperability Challenges Within Its Electronic Health Record System
  6. Projects for Assistance in Transition from Homelessness Program

Find the full list of Recently Added Items on OIG’s site. Did you miss a monthly OIG Work Plan update? Find all of the archived releases by searching ProviderTrust Work Plan posts


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

The U.S. Department of Health and Human Services (HHS) continues its efforts to combat the opioid epidemic with resources and programs aimed at providing more mental health and substance abuse services. In 2017, $200 million was awarded to Access Increases in Mental Health and Abuse Services (AIMS) to 1,178 health centers nationwide to help aid in supplemental funding.

HHS OIG will be determining whether these health centers used their funding in accordance with federal requirements.


Quality of Medicaid Encounter Data

Healthcare data can become very complicated with inefficient systems and questionable accuracy. As we’ve seen in particular, managed care organizations see this dilemma quite often. HHS OIG will be reviewing three to five states to make sure that Transformed Medicaid Statistical Information System (T-MSIS) data contains quality and required data for Medicaid oversight.


Medicaid Managed Care Organization Denials

Contractual arrangements between Managed Care Organizations (MCOs) and the federal government and state Medicaid agency can sometimes create some issues for beneficiaries as access to covered service is denied.

The Office of Inspector General (OIG) will review whether or not certain MCOs were compliant with federal requirements while denying access to medical, dental, and prescription services that require prior authorization.


Deficiencies in a State Foster Care System

HHS OIG will be evaluating the Foster Care Program relative to how well each state agency (according to Title IV-E) is adhering to health and safety requirements. Foster care group homes are required to comply with health and safety standards including criminal background checks, proper licensing requirements, and more.

The assessment will also take into account how well the state agency is locating children who are missing from foster care and apply corrective actions to current procedures, if necessary.


Audit of National Institutes of Health Information Technology and Interoperability Challenges Within Its Electronic Health Record System

CMS has been very active in promoting interoperability with its news releases and programs to increase the quality of care. The federal government has been adamant about making EHR more readily available to the correct individuals in modern terms of access and exchange.

In this update, OIG will be examining the operations of the National Institute of Health (NIH) and determine if system controls are in place according to federal regulations and appropriately address the challenges of EHR interoperability.


Projects for Assistance in Transition from Homelessness Program

The PATH (Projects for Assistance in Transition from Homelessness) program helps support outreach and services to individuals with a history of substance abuse disorders and mental illness who experience or are at risk of becoming homeless.

In 2018, $62 million in grants were administered to various states from SAMHSA in support of the PATH program. HHS OIG will be determining if recipients remained compliant in accordance with federal requirements for providing PATH services.


Other updates to the April 2019 OIG Work Plan include the following:

  • Sufficiency and Implementation of Indian Health Service Patient Abuse Policies
  • Review of State Uncompensated Care Pools
  • Review of Monthly ESRD-Related Visits Billed by Physicians or Other Qualified Healthcare Professionals
  • Medicaid Personal Care Services

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Written by Michael Rosen, Esq.

ProviderTrust Co-Founder, mrosen@providertrust.com

Michael brings over 20 years of experience founding and leading risk mitigation businesses, receiving numerous accolades such as Inc. Magazine’s Inc. 500 Award and Nashville Chamber of Commerce Small Business of the Year.

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