As we announced earlier this year, the Office of Inspector General (OIG) is updating its Work Plan monthly rather than its previous twice-yearly publications. The November updates include 4 new Work Plan items:

  1. Opioids in Medicaid: Concerns about Extreme Use and Questionable Prescribing in Selected States. Focusing on the opioid public health emergency, OIG will identify Medicaid beneficiaries who received extreme amounts of opioids that appear to involve doctor or pharmacy shopping, and the prescribers associated with these beneficiaries. The review will provide baseline data regarding Medicaid beneficiaries receiving extreme amounts of opioids and prescribers with questionable opioid prescribing patterns.
  2. Medicaid Systems Delivered Using Telecommunication Services. OIG will determine whether Medicaid is paying for telemedicine, telehealth, and telemonitoring services delivered through a range of interactive video, audio or data transmission services in accordance with Medicaid requirements.
  3. Medicare Claims on Which Hospitals Billed for Severe Malnutrition. OIG will determine whether providers are complying with Medicare billing requirements when assigning diagnosis codes for the treatment of severe malnutrition on inpatient hospital claims, which can result in a higher Diagnosis Related Group (DRG) Medicare payment.
  4. Use of Funds by Medicaid Managed Care Organizations. OIG will examine how Medicaid funds received by Medicaid Managed Care Organizations (MCOs) in the form of capitation payments are used to provide services to enrollees.

Posted by Cooley