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 items from this month.

February’s agenda includes nine 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. NIH Inventory of its Information Technology Resources and Information Systems
  2. Nursing Facility Staffing: Reported Levels and CMS Oversight
  3. Characteristics of Part D Beneficiaries at Serious Risk of Opioid Misuse or Overdose
  4. Ensuring Dual-Eligible Beneficiaries’ Access to Drugs Under Part D: Mandatory Review

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 clicking here.

NIH Inventory of its Information Technology Resources and Information Systems

This month there are quite a few Work Plan updates involving the National Institutes of Health (NIH). The research agency, under HHS, is in charge of making important research discoveries that improve health and help save lives. The NIH currently has 27 institutes and centers across the country, with each facility having specific research priorities and projects.

Because of the separation of locations and research projects, the information systems and IT resources vary widely and the OIG will be evaluating whether NIH is meeting federal requirements for reporting and keeping an inventory of its IT resources and information systems.

Read the full update from OIG here.


Nursing Facility Staffing: Reported Levels and CMS Oversight

The OIG’s continued focus on skilled nursing facilities and post-acute facilities remains a top priority as it pertains to quality of care, sufficient staffing requirements, and any fraud, waste, or abuse that might be taking place. Facilities that bill Medicaid and Medicare are required to provide sufficient staffing of licensed nurses for 24 hours a day service with an RN available for at least 8 consecutive hours each day as well.

The Centers for Medicare and Medicaid Services (CMS) uses a centralized staffing data system (Payroll-Based Journal) to help keep track of auditable daily staffing patterns, and to assist the general public to evaluate the quality of care provided at each nursing facility. The Office of Inspector General (OIG) will be producing two reports in order to evaluate the data provided to the PBJ and to examine CMS’s efforts to ensure data accuracy and public transparency involving quality of care.

Find out more information here.


Characteristics of Part D Beneficiaries at Serious Risk of Opioid Misuse or Overdose

As many Medicare beneficiaries qualify for Medicare Part D prescriptions, the importance of effectively monitoring the serious risks of opioid misuse and overprescribing remains a priority for OIG and law enforcement. In a recent data report, OIG found that 71,000 Part D beneficiaries are at serious risk of misuse or potential opioid overdose.

These numbers are frightening and remain a top challenge for OIG’s efforts in combatting the opioid epidemic in the United States. For this particular update, a study will be provided to help provide key information involving: (1) demographic and diagnoses of at-risk beneficiaries; (2) opioid utilization for beneficiaries; (3) adverse effects related to overdoses and opioid abuse.

To read more about this report visit the OIG’s site – here.


Ensuring Dual-Eligible Beneficiaries’ Access to Drugs Under Part D: Mandatory Review

According to the Affordable Care Act, § 3313, the Office of Inspector General (OIG) is required to conduct an annual review to determine the extent at which drug formularies developed by Part D sponsors include drugs commonly used by dual-eligible beneficiaries.

To read the full update, visit the HHS OIG website here.


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

  • Medicare Part B Payments for Podiatry and Ancillary Services
  • NIH Monitoring of Extramural Researchers’ Financial Conflicts of Interest
  • NIH’s Implementation of Financial Conflict of Interest Regulations
  • NIH’s Pre-Award Process for Assessing Risk of Grant Applicants and Post-Award Process for Oversight of Grantees
  • NIH’s Peer Review Process for Evaluating Grants

Do you have any recent experience or information concerning OIG’s Work Plan updates for February? Maybe there’s a question you are urgent to ask for more insight. 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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