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Late-released 2014 OIG Work Plan Has Something For Everyone

on Wednesday, 26 March 2014 in Health Law Advisory: Zachary J. Buxton, Editor

Long recommended as a key document in compliance risk assessment, the 2014 Work Plan covers all provider types and continues the practice of reprinting the descriptions of projects that are conducted over more than one year. The Work Plan is usually issued in October, but was released late (January 31, 2014) due to delays caused by the sequester.

 

The Work Plan denotes projects listed for the first time in 2014 as “new” in both the hyperlinked Table of Contents and in the body of the Plan for ease of identification. Appendix A describes projects related to the Affordable Care Act and Appendix B tracks projects funding under the American Recovery and Investment Act of 2009.

 

Readers should review the entire Table of Contents carefully for potentially applicable reviews. Although there are sections for each provider type, pertinent reviews may also pop up under separate sections on Medicare Parts A, B, C and D as well as under Medicaid reviews.

 

Finally, the Work Plan confirms the OIG’s intention to continue “data mining” Medicare and Medicaid claims data to detect trends that might be indicative of fraud, waste and abuse.

 

Another feature related to the Work Plan is the OIG Outlook 2014, a 22-minute video posted on the OIG website www.oig.hhs.gov. The website describes the program as follows: “Our senior executives discuss emerging trends in combating fraud, waste, and abuse in Federal health care programs, OIG’s top priorities for 2014, and upcoming projects in the newly released OIG Work Plan.” This is probably worth a look by your Compliance Committee for additional background on the OIG’s priorities and approaches.

 

It’s Not Just About the Money. Speaking of approaches and priorities, Stuart Delery, Assistant United States Attorney General who leads the Civil Division at the Department of Justice, has been recently quoted from his keynote presentation to the CBI Pharmaceutical Compliance Conference in early 2014. His message is that financial sanctions against errant providers and suppliers are insufficient. The Justice Department is taking a broader view to encourage systemic change and improvement in compliance programs; e.g., requiring policy revisions and particular steps in implementation.

 

This follows other proactive moves in health care enforcement such as requiring Boards of Directors to annually certify to compliance by their organizations as part of settlements of False Claims Act and other allegations.

 

RAC “Pause.” In case you missed it, a February 18, 2014, post to the CMS website announced a pause in new RAC reviews:

 

“CMS is in the procurement process for the next round of Recovery Audit Program contracts. It is important that CMS transition down the current contracts so that the Recovery Auditors can complete all outstanding claim reviews and other processes by the end date of the current contracts. In addition, a pause in operations will allow CMS to continue to refine and improve the Medicare Recovery Audit Program. Several years ago, CMS made substantial changes to improve the Medicare Recovery Audit program. CMS will continue to review and refine the process as necessary. For example, CMS is reviewing the Additional Documentation Request (ADR) limits, timeframes for review and communications between Recovery Auditors and providers. CMS has proven it is committed to constantly improving the program and listening to feedback from providers and other stakeholders. Providers should note the important dates below:

  • February 21 is the last day a Recovery Auditor may send a post payment Additional Documentation Request (ADR)
  • February 28 is the last day a MAC may send prepayment ADRs for the Recovery Auditor Prepayment Review Demonstration
  • June 1 is the last day a Recovery Auditor may send improper payment files to the MACs for adjustment

 

CMS will continue to update this website with more information on the procurement and awards as information is available. Providers should contact RAC@cms.hhs.gov for additional questions.

Julie A. Knutson

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