Reviews of Medicare and Medicaid payments, fraud and abuse, and employee background check efforts are some of the items on the agenda for the Department of Health and Human Services Office of Inspector General, according to a 2017 work plan released Thursday.
Some of the upcoming projects planned for the OIG are listed below. Unless otherwise noted, reports are expected to be issued in fiscal year 2017.
- Room and board under HCBS waivers. The OIG will examine whether selected states inappropriately claimed federal reimbursement for room and board costs associated with services provided via Medicaid home- and community-based services waiver programs. The office also will determine whether HCBS payments included the costs of room and board and identify the methods the states used to determine the amounts paid.
- Oversight and effectiveness of Medicaid waivers. HHS will ascertain the extent to which selected states used Medicaid waivers and whether costs associated with the waivers are efficient, economic and do not inflate federal costs. The OIG also will examine CMS’ oversight of state Medicaid waivers. Expected issue date for the report: fiscal year 2018.
- Transitional care management. The office will discern whether Medicare payments for transitional care management during transitions from hospitals or skilled nursing facilities to community settings (defined as homes, domiciles, rest homes or assisted living communities) meet Medicare requirements.
- Employee background checks. The OIG will review the procedures that certain states have implemented related to background checks that long-term care facilities and providers are required to perform under the Affordable Care Act on prospective employees who would have direct access to residents. HHS will determine the outcomes of the programs and whether the background checks led to any unintended consequences. LTC employees, according to the Centers for Medicare & Medicaid Services, include personal care providers and residential care providers arranging for or providing LTC services.
- Personal care fraud and abuse. The office will issue a data brief on fraud in Medicaid personal care services that will illustrate the prevalence and magnitude of fraud and patient abuse or neglect involving personal care services.
- Adult day healthcare services. Medicaid allows payments for adult day healthcare through various authorities, including HCBS waivers. The OIG plans to review Medicaid payments by states for adult day healthcare services to determine whether providers complied with federal and state requirements.
- Transportation services. HHS will determine the appropriateness of Medicaid payments by states to providers for transportation services enabling beneficiaries to travel to and from providers.
- Transfers to hospitals. Stating that high occurrences of emergency transfers could indicate poor quality of care, the OIG said it will review the rate of and reasons for transfers from group homes or nursing facilities to hospital emergency departments.
See the work plan for additional information.