Each month, we will be sharing the most recent additions to the Office of Inspector General (OIG) Work Plan items. As of June 2017, OIG updates their Work Plan monthly with any new changes to the active list. Let’s take a look at the new points of emphasis for compliance professionals moving forward.

Here are the following Recently Added Items to the OIG Work Plan:

  1. Review of the Patient Safety Organization Program
  2. Duplicate Drug Claims for Hospice Beneficiaries
  3. Medicare Part B Payments for Psychotherapy Services
  4. Ventilation Devices: Reasonableness of Medicare Payments Compared to Amounts Paid in the Open Market

Find the full list of Recently Added Items on OIG’s site. Looking for last month’s added items? Take a look at July’s OIG Work Plan Updates.

Let’s walk through some of these updates so you can address each item within your compliance program.

Review of the Patient Safety Organization Program

The Patient Safety and Quality Improvement Act was established in 2005 and would be the determining factor for the creation of the Patient Safety Organization (PSO) program. The Agency for Healthcare Research and Quality (AHRQ) is in charge of oversight for the project, while PSOs aim to serve the purpose of improving patient care quality and safety. OIG will continue to evaluate the AHRQ’s management of the program and work to uncover current or future constraints of implementation.

See the full update here.

Duplicate Drug Claims for Hospice Beneficiaries

OIG has identified some overlap in Medicare Part A and Part D coverage for prescription drugs for beneficiaries with a terminal illness or related condition. Reducing the redundancy in payments will help OIG determine the appropriateness for Part D hospice claims when Part A is already being applied.

Read the latest info on these Medicare prescription drug discrepancies here.

Medicare Part B Payments for Psychotherapy Services

For the 2016 calendar year, an OIG Review found that many payments for psychotherapy services covered under Medicare Part B were problematic. In fact, $185 million was paid in inappropriate outpatient mental services (psychotherapy services included). OIG is alarmed to find that many services were paid for but were not covered, medically unnecessary, or inadequately documented.

Read more about problematic mental health Medicare payments here.

Ventilation Devices: Reasonableness of Medicare Payments Compared to Amounts Paid in the Open Market

Ventilation devices are vital to patient care and well being, and while many similar device costs have gone down, ventilation devices have continued on an upward trend starting in 2011. OIG is researching the reason for this problem and how to address rising costs, given relative prices on the open market.

Find out how much ventilation devices prices have increased here.

Do you have any recent experience or background information concerning OIG’s Work Plan updates for August? Let us know in the comments below!


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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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