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 points from this month.  

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

  1. Assessing Inpatient Hospital Billing for Medicare Beneficiaries
  2. Involuntary Transfer and Discharge in Nursing Homes
  3. Protecting Medicare Hospice Beneficiaries From Harm
  4. Adverse Events in Hospitals: National Incidence Among Medicare Beneficiaries – 10-Year Update

Find the full list of Recently Added Items on OIG’s site. Did you miss a monthly OIG Work Plan update? Find all of this year’s releases by clicking here.

November’s agenda includes 6 new items from the HHS Office of Inspector General (OIG). Let’s walk through these updates so you can address each item within your compliance program, if applicable.

Assessing Inpatient Hospital Billing for Medicare Beneficiaries

When it comes to Medicare expenses, inpatient hospital stays account for 17 percent of all payments. Both the Office of Inspector General (OIG) and the Center for Medicare and Medicaid Services (CMS) have identified issues regarding hospital billing upcoding that can have drastic effects when it comes to increased payment and overbilling.

To combat this problem, OIG will be conducting a study to both analyze Medicare claims data, and determine how inpatient billing has changed over time and its variation between health systems and facilities.

Read the full update from OIG here.

Involuntary Transfer and Discharge in Nursing Homes

It’s hard to imagine that loved ones could be evicted from a skilled nursing facility or long-term care center. Unfortunately, in the latest estimate, the Centers for Medicare and Medicaid Services (CMS) believe that as many as one-third of all residents in long-term care facilities are involuntarily discharged.

OIG will be evaluating the extent to which the Long-Term Care Ombudsman Program (established under the Older Americans Act of 1965) is addressing involuntary transfers and discharges from nursing homes, and how often state agencies took enforcement actions to address this issue.

Find out more information here.

Protecting Medicare Hospice Beneficiaries From Harm

OIG will be conducting a study regarding the quality of care provided to Medicare beneficiaries in the hospice program. The review will be aligned with the findings from the Trends in Hospice Deficiencies and Complaints (02-17-00020). OIG will be examining complaints and deficiencies from a variety of survey reports to determine the level of poor quality care resulting in harm to beneficiaries.

To find out more information, click here.

Adverse Events in Hospitals: National Incidence Among Medicare Beneficiaries – 10-Year Update

The Office of Inspector General (OIG) continues to highly prioritize evaluation of quality care provided for elderly individuals. Utilizing data to report findings and quantify the impact of poor care on the entire federal system is top of mind for continuous improvement.

OIG will be comparing results from a study conducted in 2008 to evaluate progress in reducing harm (adverse events) for Medicare beneficiaries over time.

To find out more information regarding this reporting update, please visit here.


Other updates to the November 2018 OIG Work Plan include the following:

  • CDC’s Oversight of the President’s Emergency Plan for AIDS Relief Funds
  • Grantees’ Use of President’s Emergency Plan for AIDS Relief Funds

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