OIG Details Health Investigation Plan for 2012 - Texas Journal of Chiropractic

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OIG Details Health Investigation Plan for 2012

Published 01/10/2012 - 6:10 a.m. CDT

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Medpagetoday.com REPORTS HERE that "Doctors opting out of Medicare, fraudulent Medicare claims, and erroneous Medicare payments for erectile dysfunction drugs are just a few of the issues the Department of Health and Human Services' Office of Inspector General (OIG) will be looking into in 2012."

"The OIG, which was created to protect the integrity of programs within the department, recently released its work plan for the new year."

The OIG will investigate the extent to which doctors have already opted out of Medicare, and will investigate whether doctors actually have stopped submitting claims to Medicare.

The OIG will analyze Medicare claims data to determine whether physician ownership of spinal implant companies and distributors leads to higher use of spinal implants.

The OIG will determine whether chiropractic claims submitted to Medicare are appropriate.

The OIG will review medical records and medical claims to see whether hospitals are accurately reporting present-on-arrival indicators.

OIG will review Medicare payments to hospitals and identify those that routinely submit improper claims. Based on that information, OIG will select hospitals for a more focused review and may recommend recovery of overpayments made to certain hospitals. OIG will then compare compliance practices of "risky" and "least risky" hospitals.

The office will look at include rates of adverse events and preventable hospital readmissions from post-acute-care settings.

The OIG notes that the Medicare Payment Advisory Commission has suggested that hospices and nursing facilities may be involved in inappropriate enrollment and compensation, including hospices that have "aggressively marketed their service to nursing facility residents."

Government insurance programs will pay for off-label use of drugs as long as the use is supported by an authoritative drug compendium endorsed by the Department of Health and Human Services. OIG will examine how widespread off-label prescribing is and whether the prescribing meets government standards for reimbursement.

Annual changes in prices for brand-name prescription drugs used by Medicare Part D drug plans. The OIG wants to determine whether Part D prices are rising faster than inflation.

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