HHS inspectors will visit several large vendors in fiscal 2005 to determine if actual rebates to hospitals match what hospitals list on their Medicare cost reports, according to the HHS' inspector general's fiscal 2005 work plan.
The plan, identifying agency priorities for 2005, revisits familiar ground and explores new areas recently discussed by agency staffers. Ongoing interests include critical-access hospitals, diagnosis-related group coding, hospital reporting of restraint-related deaths and long-term acute-care hospitals. The plan significantly emphasizes prescription-drug issues, said Eve Brunts, a healthcare attorney in the Boston office of Ropes & Gray. "That's not surprising," Brunts said, considering the new Medicare drug benefit.
In addition to vendor rebates, new interests include the medical necessity of inpatient psychiatric stays and hospitals' compliance with beneficiary notification requirements for "lifetime reserve days," a nonrenewable Medicare benefit that Congress ordered the inspector general's office to track.
In the wake of a year just passed that was fraught with billing delays by claims clearinghouses, which blamed computer snafus caused by HIPAA compliance, the OIG also will look at "billing services and determine the impact of these arrangements on the physicians' billings."
The plan also includes reference to preliminary work indicating Medicare reimbursed $105 million between Jan. 1, 2001, and June 30, 2003, for services by physicians who also received pay from the Department of Veterans Affairs. The OIG will use time and payroll documentation from the VA to see if the services billed to Medicare were rendered while the physicians were on the clock for the VA, a no-no.
The investigators also will probe services ordered by physicians who had been excluded from the Medicare program, the relationship between physicians who furnish pathology services in their offices and outside pathology companies, and possible duplicate payments under Medicare Part A and Part B for "overlapping services for skilled nursing facility patients."
The 92-page work plan was released Monday on the office's Web site. Read the work plan.