HHS inspector generals office posted its to-do list for the next year, providing hospitals and physicians a 115-page guide to what the watchdog intends to watch.
Lewis Morris, the inspector generals chief counsel, often advises lawyer groups he addresses to take a look at the annual document, and this yearsOffice of the Inspector General Work Plan Fiscal Year 2009includes many new areas of interest.
Several new items involve Medicare payments to hospitals, including whether hospitals have sufficient controls in place to ensure the validity of quality data theyre submitting to the CMS for Medicare reimbursement, and compliance with the Emergency Medical Treatment and Active Labor Act, or EMTALA, which is intended to prevent patient dumping. A previous OIG review raised concerns about CMS EMTALA oversight, specifically regarding long delays to investigate complaints and inadequate feedback provided to hospitals on alleged violations, the plan states, explaining a project that will look for regional variations in the number of complaints and the CMS methods for tracking them.
The office intends to determine whether hospitals are appropriately collecting outpatient reimbursement for services provided by their hospital-owned physician practices designated as provider-based. Additionally, it will assess the effect on Medicare of the higher reimbursement rate that same services would cost the government under the physician fee schedule. Another project will look at whether Medicare severity-adjusted diagnosis-related groups, or MS-DRGs, adopted in October 2007 for inpatient hospital services, have been vulnerable to upcoding.
The office also promises to commit resources to studying Medicare dollars paid to physicians, including a review of actual expenses borne by selected physician specialties to find out if Medicare payments reflect the real costs.
The policies and procedures of the CMS will likewise be under the lens. The workplan includes an evaluation of the CMS response to an August finding that the CMS drastically underestimated the rate of errors and potential fraud among claims for durable medical equipment by basing the figures on a statistical sampling superficially reviewed by a contractor. Other CMS functions targeted are the agencys efforts to deter or mitigate the impact of Medicare fraud committed through medical identity theft and oversight of recovery audit contractors.