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 May agenda includes 9 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. Audit of Nursing Home Infection Prevention and Control Program Deficiencies
  2. Audit of CARES Act Provider Relief Funds-Distribution of $50 Billion to Health Care Providers
  3. Nursing Home Oversight During the COVID-19 Pandemic
  4. Medicare Part D Payments for Transmucosal Immediate-Release Fentanyl Drugs
  5. Monitoring Psychotropic Drug Use in Nursing Homes

Audit of Nursing Home Infection Prevention and Control Program Deficiencies

Government authorities and healthcare providers continue to help build awareness and keep high-risk individuals safe from the spread of COVID-19. As we have learned from the U.S. Center for Disease Control (CDC), those who are 65 years and older are considered most seriously at risk for developing a severe illness related to COVID-19. 

In the United States, more than 1.3 million residents live in approximately 15,450 Medicare- and Medicaid-certified nursing homes in the United States. Unfortunately, nearly 43 percent of these types of facilities have been cited for infection prevention and control program deficiencies as of February 2020. 

CMS requires that nursing home facilities have internal controls in place to reduce the spread infection. HHS OIG will be conducting an audit to determine if selected nursing homes have programs in place for infection prevention and control and emergency preparedness in accordance with federal requirements.


Audit of CARES Act Provider Relief Funds-Distribution of $50 Billion to Health Care Providers

The Coronavirus Aid, Relief, and Economic Security (CARES) Act disbursed $50 billion in Provider Relief Fund (PRF) payments to hospitals and other providers to respond to COVID-19. To help learn more about how those payments, HHS OIG will obtain data and interview program officials to gain an understanding of how PRF payments were calculated and review PRF payments for compliance with CARES Act requirements. 

HHS OIG is aimed at determining whether HHS controls over PRF payments ensured that CARES Act payments were correctly calculated and disbursed to eligible providers.


Nursing Home Oversight During the COVID-19 Pandemic

The Centers for Medicare and Medicaid Services (CMS) has directed State Survey Agencies (SSAs) to suspend standard onsite nursing home surveys and most onsite surveys for complaints during emergency response to the Coronavirus (COVID-19). These surveys are critical in safeguarding nursing home residents from any unsafe conditions or questionable quality of care. 

To address specific nursing home concerns during the COVID-19 pandemic, CMS has ordered that onsite survey are only appropriate for the following : 

  • Complaints involving immediate jeopardy
  • Complaints related to infection control
  • Target infection control surveys (abbreviated and focused on policies and practices)

HHS OIG will be utilizing recent nursing home complaint and survey data, and conduct a study that will examine the extent to which SSAs and CMS are conducting onsite surveys in nursing homes related to serious complaints and targeted infection control, in accord with CMS’s recent guidance.


Medicare Part D Payments for Transmucosal Immediate-Release Fentanyl Drugs

Medicare Part D covers Transmucosal Immediate-Release Fentanyl (TIRF) drugs only for managing breakthrough pain in adult cancer patients who are already receiving and are tolerant to around-the-clock opioid therapy for their underlying persistent cancer pain. HHS OIG will be determining whether TIRF drugs were appropriately dispensed in Medicare Part D in accordance with Medicare requirements.


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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