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 December updates include 6 new Work Plan items:
- Status Update on States’ Efforts on Medicaid-Provider Enrollment. OIG will follow-up on a previous review to determine the extent to which States have completed fingerprint-based criminal background checks and site visits as part of provider enrollment. OIG also will determine challenges that prevent States from completing fingerprint-based criminal background checks and site visits.
- Review of CMS Systems Used to Pay Medicare Advantage Organizations. OIG will conduct analysis of CMS’ current data systems and its transition to a new system for making risk-adjusted payments, including the continuity of data maintained on current Medicare Part C systems and whether a requisite diagnosis code correctly mapped to a hierarchical condition category (HCC).
- State Compliance With Requirements for Reporting and Monitoring Critical Incidents. OIG will expand on a previous audit by reviewing additional State Medicaid Agencies to determine whether the selected States are in compliance with reporting and monitoring requirements for critical incidents for Medicaid beneficiaries residing in both community-based settings and nursing facilities.
- Paper Check Medicaid Payments Made to Mailbox-Rental Store Addresses. A report by the Government Accountability Office (GAO) identified an increased risk of fraud, waste, or abuse when payments are made to Medicaid providers with a mailbox-rental store, vacant, or invalid practice address. OIG will determine whether similar problems exist with the Medicaid program, including whether Medicaid payments issued by paper checks to providers with mailbox-rental locations are for unallowable services.
- Prescription Opioid Drug Abuse and Misuse Prevention – Prescription Drug Monitoring Programs. OIG will identify actions State agencies have taken using Federal funds for enhancing prescription drug monitoring programs (PDMPs) to improve safe prescribing practices, prevent prescription drug abuse and misuse, and comply with Federal requirements. This series of audits includes States that have a high number of overdose deaths, significant increase in the rate of drug overdose deaths, or received HHS funding to enhance their PDMPs.
- Impact of the Indian Health Service’s Delivery of Information Technology/Information Security Services and Opioid Prescribing Practices. OIG will analyze information technology/information security (IT/IS) operations and opioid prescribing practices at five Indian Health Service (IHS) hospitals to determine whether (1) IHS’s decentralized management structure has affected its ability to deliver adequate IT/IS services in accordance with Federal requirements; and (2) hospitals prescribed and dispensed opioids in accordance with IHS policies and procedures.