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
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.