The U.S. Department of Health and Human Services Office of the Inspector General (OIG) has released its Work Plan for 2013. This report is an overview of the areas in the health care sector which the OIG plans to investigate during its 2013 fiscal year. One of the primary duties of the OIG is to ensure that health care facilities are in full compliance with established Medicare and Medicaid laws.
Here are a few issues from the 2013 OIG Work Plan relevant to hospices and nursing homes receiving Medicare Part A and Part B funding:
Hospices
- In 2013, OIG will review hospices’ marketing materials and their relationships with nursing facilities. Specifically, OIG will investigate situations in which hospices are aggressively marketing their services to nursing facility residents. OIG will target hospices that have a high percentage of Medicare beneficiaries in nursing facilities.
- OIG plans to assess the appropriateness of hospices’ general inpatient Medicare claims. In doing so, OIG will ensure that all hospice Medicare beneficiaries have previously qualified for Medicare Part A and have been properly certified as being “terminally ill.”
Nursing Homes
- OIG will review nursing homes’ use of the Federally required Residential Assessment Instruments (RAIs) to determine whether nursing homes are using RAIs properly to enhance quality of care.
- OIG will follow-up State survey recertification results for nursing homes to ensure that the nursing homes have corrected any previously-identified deficiencies.
- OIG will examine instances in which Medicare beneficiaries in nursing homes have been hospitalized to determine whether these hospitalizations were the result of manageable or preventable conditions.
- OIG will investigate nursing homes’ Medicare Part B billing practices to ensure that they are in compliance with Federal regulations.
For more information on how OIG’s 2013 Work Plan impacts the operation of nursing homes or hospices, contact one of DLM Legal’s attorneys today at info@dlmlegal.com or 216.635.0002.