Highlights include Medicaid specialty drug reimbursement, managing ICD-10 implementation
The U.S. Department of Health and Human Services Office of Inspector General (OIG) issues an annual work plan summarizing the health program reviews planned by OIG for the upcoming year. Its Fiscal Year 2016 Work Plan provides important information and guidance to healthcare executives. Here are some of the key takeaways.
The work plan states that OIG expects recoveries from providers and health plans of more than $3 billion for 2015. Further, the legislative, regulatory and administrative actions OIG supported saved approximately $20.6 billion last year.
OIG reviews resulted in the exclusion of 4,112 individuals and entities from participation in federal healthcare programs; 925 criminal actions; and 682 civil actions, including false claims and unjust-enrichment cases.
In June 2015, OIG participated in the largest national healthcare fraud intervention in its history, resulting in more than 240 subjects being charged with defrauding Medicare and Medicaid.
OIG will expand its focus on delivery system reform and the effectiveness of alternate payment models, coordinated care programs and value-based care purchasing.
Data analytics will be used to identify additional issues for further analysis and scrutiny.
As more attention is directed to addressing the rising cost of healthcare, reviews and enforcement actions can be expected to increase.
Next: New areas the OIG will review
Medicaid
Medicare Parts C and D
Affordable Care Act (ACA)
Medicare Parts A and B:
Deborah Dorman-Rodriguez is a Partner at Freeborn & Peters LLP, and is the leader of the Firm's Healthcare Practice Group.
David Kaufman is a Partner at Freeborn & Peters LLP, and serves as a key member of the Firm's Healthcare Practice Group.
Emerging Therapies Committee at UC Davis Hits the Accelerator Not the Brake | AMCP 2024
April 18th 2024After the onboarding of cell and gene therapy bogged using normal pharmacy and therapeutics (P&T) committee procedures, UC Davis Health set up an emerging therapeutics committee to streamline and speed up the process of delivery expensive cell and gene therapies.
Read More
DC Roundtable: Patrick Cooney of The Federal Group Drops the Latest on PBM Legislation in Washington
April 11th 2024In this episode of "DC Roundtable," Peter Wehrwein, managing editor of Managed Healthcare Executive, spoke with Patrick Cooney, president of The Federal Group, a lobbying and strategic planning firm in Washington, D.C., about recent developments in Washington concerning PBMs.
Listen
2024 Emerging Leaders in Healthcare — Submit For a Chance to Be Featured in MHE's August Issue
April 18th 2024MHE Editors are seeking diverse healthcare professionals from different backgrounds and healthcare sectors, with individual interests. Eligible candidates are early or mid-career leaders with less than 10 years of experience. Award winners will enjoy complimentary passes to the PBMI Annual National Meeting in Orlando, Florida, from Sept. 4-6. Additional perks include a feature in our August issue, a subscription to MHE and more!
Read More