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OIG and HHS Release FY 2014 Work Plan

The Office of Inspector General (OIG) and the U.S. Department of Health and Human Services (HHS) released their fiscal year (FY) 2014 work plan. The work plan summarizes reviews and activities related to HHS programs that OIG plans to pursue during the current FY and beyond. Among the projects listed in the work plan are the following Medicare and Medicaid reviews and activities:

  • For Medicare
    • determining the impact of new inpatient admissions criteria on hospital billing, Medicare payments, and beneficiary payments
    • determining whether or not having a provider-based status impacts Medicare billing by subordinate facilities (facilities that are part of a hospital) and the extend of that impact
    • comparing Medicare payments for physician office visits in clinics that are based at hospitals versus clinics that are freestanding
    • reviewing outpatient payments to hospitals for evaluation and management services that were billed at the new patient rate
    • determining whether hospitals’ indirect medical education (IME) payments were made in accordance with federal regulations; IME payments are made to teaching hospitals to account for the fact that the specialty and research services they provide result in higher costs of care
  • For Medicaid
    • determining whether states made Medicaid payments to hospitals for services related to conditions that arose during a hospital stay (hospital-acquired conditions); federal regulations prohibit such payments
    • determining whether the provider taxes that states impose on Medicaid providers to generate federal Medicaid funding comply with federal requirements
    • determining state compliance with federal regulations for claiming certified public expenditures, which are sources of funding for a state’s share of Medicaid payments

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