Each month, we are pleased to share the most recent additions to the HHS Office of Inspector General (OIG) Work Plan items. HHS OIG updates its Work Plan monthly with new changes to the active list. Let’s take a look at the new updates from this month.

What is the OIG Work Plan?

The HHS OIG Work Plan sets forth various projects that OIG plans to undertake during the fiscal year (FY) and beyond.

Projects listed in the Work Plan span HHS’s operating divisions, including the following: 

  • Centers for Medicare & Medicaid Services (CMS)
  • Public health agencies such as the Centers for Disease Control and Prevention (CDC)
  • National Institutes of Health (NIH)
  • Administration for Children and Families (ACF)
  • Administration for Community Living (ACL)
  • Various state and local governments – evaluating the use of federal funds as well as the administration of HHS

*Some of the projects described in the Work Plan are statutorily required.

The June agenda includes 16 new items from HHS Office of Inspector General (OIG). Let’s walk through this latest release so you can address it within your compliance program, if applicable. 

  1. A Review of Medicare Data To Understand Hospital Utilization During COVID-19
  2. Trend Analysis of Medicare Laboratory Billing for Potential Fraud and Abuse With COVID-19 Add-on Testing
  3. Medicaid—Telehealth Expansion During COVID-19 Emergency
  4. Meeting the Challenges Presented by COVID-19: Nursing Homes
  5. Opioid Treatment Program Challenges During the COVID-19 Pandemic
  6. Audit of Nursing Homes’ Reporting of COVID-19 Information Under CMS’s New Requirements
  7. Utilization of Medication-Assisted Treatment in Medicare

A Review of Medicare Data To Understand Hospital Utilization During COVID-19

To better understand the scope of the impact on healthcare systems during COVID-19, HHS OIG will be conducting a review of Medicare data. This review will analyze Medicare claims data during COVID-19 for hospitalized Medicare beneficiaries to discover patient impacts and hospital resources necessary for treatment. OIG will be evaluating the utilization of treatment paid for by Medicare for patients with COVID-19 in selected localities that have known outbreaks or Coronavirus hotspots.


Trend Analysis of Medicare Laboratory Billing for Potential Fraud and Abuse With COVID-19 Add-on Testing

Healthcare diagnostic laboratory testing is at an all-time high, given the demand for COVID-19 testing. In addition to COVID-19 tests, these laboratories may include additional tests to rule out or confirm other diagnoses. HHS OIG has concerns over the program integrity with additional tests to COVID-19 including respiratory pathogen panel (RPP) tests, allergy tests, or genetic tests. 


During the public health emergency, CMS has relaxed rules related to COVID-19 testing and other associated diagnostic laboratory testing to no longer require an order from the treating physician or nonphysician practitioner (NPP) during the COVID-19 pandemic. OIG will conduct a study that will examine Medicare claims data for laboratory testing to identify trends in the use of RPP, allergy, and genetic testing and identify patterns of billing by laboratories that may indicate fraud and abuse.


Medicaid—Telehealth Expansion During COVID-19 Emergency

Telehealth and virtual care have seen dramatic increases since COVID-19 has spread across the country. State Medicaid programs have expanded options for telehealth services, while HIPAA medical licensure standards have been waived during the public health emergency. With the rapid expansion of telehealth and telemedicine services, there is a fear that state agencies will not be able to effectively oversee these activities. 

HHS OIG will be determining whether state agencies and providers complied with Federal and State requirements for telehealth services under the national emergency declaration and whether the states gave providers adequate guidance on telehealth requirements.


Is your organization expanding telehealth?

View our Guide to Telehealth and Credentialing During COVID-19


Meeting the Challenges Presented by COVID-19: Nursing Homes

Nursing home and post-acute facilities are facing tremendous challenges during the outbreak of COVID-19 in America. Some of the challenges faced include procuring critical supplies and PPE, testing residents and staff, isolating high numbers of contagious residents, caring for those afflicted, and protecting staff on a scale never before experienced in this country.

HHS OIG will be conducting a two-part study on nursing homes that will examine how the COVID-19 pandemic has affected nursing homes

Part 1 – Characteristics of the nursing homes that were hardest hit by the pandemic. 

Part 2 – Strategies nursing homes have used to mitigate the effects of COVID-19 on their residents and staff in the face of these unique circumstances.

View our On-Demand Webinar

Aligning HR and Compliance During COVID-19

Opioid Treatment Program Challenges During the COVID-19 Pandemic

Before the COVID-19 pandemic, the United States was managing and trying to mitigate the opioid epidemic. Now, both of these terrible scenarios continue to be top of mind for public health and treatment as they have contributed to many American deaths over the last two years. Because of government restrictions on socializing and certain lockdowns on public interactions, the concern remains of how this is affecting those who are seeking treatment for opioid and substance use disorders.

HHS OIG will be identifying the challenges that opioid treatment programs (OTPs) are encountering during the COVID-19 pandemic. They will also identify the actions that OTPs are taking to address those challenges while ensuring the continuity of needed services and protecting the health and safety of their clients and staff.


Audit of Nursing Homes’ Reporting of COVID-19 Information Under CMS’s New Requirements

To respond to the COVID-19 public health emergency, the Centers for Medicare and Medicaid Services (CMS) added requirements to an existing regulation that requires nursing homes to report to state and local health departments communicable diseases, healthcare-associated infections, and potential outbreaks. The Centers for Disease Control and Prevention requires information on suspected and confirmed infections, and deaths among residents and staff to be reported via the National Healthcare Safety Network system. 

OIG will be evaluating nursing homes’ reporting of CMS-required information related to the COVID-19 public health emergency. The department will be also be determining whether the data reported by nursing homes were complete, accurate, and reliable.


Utilization of Medication-Assisted Treatment in Medicare

The National Institutes of Health recently issued a warning that individuals with opioid use disorder could be particularly hard hit by COVID-19. Recent OIG studies have found that the utilization of drugs for medication-assisted treatment (MAT) is low and that concerns exist related to access. OIG will assess the extent to which Medicare beneficiaries with opioid use disorder are receiving MAT drugs through Medicare and the extent to which they are receiving counseling or behavioral therapies.


Find the full list of Recently Added Items on OIG’s site.

Take a look at our recaps of all the archived releases by visiting the ProviderTrust Work Plan page.

Looking for more? Check out the latest compliance resources.

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