OIG February 2018 Work Plan Updates

Each month, we are pleased to share the most recent additions to the 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 points from this month.

A few topics that stood out to us for February’s OIG Work Plan are the following:

  1. State Medicaid Fraud Control Units FY 2017 Annual Report
  2. Review of Statistical Methods Within the Medicare Fee-For-Service Administrative Appeal Process
  3. Medicare Part B Drug Payments: Impact of Price Substitutions Based on 2016 Average Sales Prices

Find the full list of Recently Added Items on OIG’s site. Curious where to find last month’s added items? Take a look at the January OIG Work Plan Updates.

This month’s agenda is relatively small from OIG with only 3 new items. Let’s walk through some of these updates so you can address each item within your compliance program if applicable.

State Medicaid Fraud Control Units FY 2017 Annual Report

This is a much-anticipated report that our team always look forward to reviewing. The release helps give a sense of how well MFCUs are reporting actions to the Federal OIG promptly after the agency takes a final action.

According to OIG, the report “assesses MFCUs’ compliance with Federal regulations and policy, and evaluates MFCUs’ adherence to published performance standards”.

Read the full update from OIG here.

Our data team helps define clarity and provide support to better understand state Medicaid exclusions lists and MFCU reporting by releasing our Compliance Healthcare Index Report each quarter. To find the latest data information for the last quarter – 2017 Q4, visit here or click below.

Review of Statistical Methods Within the Medicare Fee-For-Service Administrative Appeal Process

Medicare Administrative Contractors (MACs) and QUalified Independent Contractors (QICs) are heavily involved in the fee-for-service appeal process when it comes to identifying if providers submitted improper payments for Medicare.

OIG will be evaluating the review process of these organizations when they are analyzing statistical samples and providing a differentiating amount than what was previously paid out.

To find out more about how OIG is addressing this process, visit here.  

Medicare Part B Drug Payments: Impact of Price Substitutions Based on 2016 Average Sales Prices

Medicare drug payment savings are essential for an effective program for beneficiaries. Such prices are set as a direct result of the CMS price substitution policy.

OIG will be releasing a report that will help distinguish cost savings when it comes to Medicare Part B drug reimbursement as it pertains to average sales price (ASP) and average manufacturer prices (AMPs).

Read more on this report here.

Do you have any recent experience or background information concerning OIG’s Work Plan updates for February? 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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