The OIG’s 2009 Work Plan and Steps Hospitals Should Undertake

The OIG recently issued its 2009 Work Plan, which identifies issues and projects that will become the primary focus of the OIG’s efforts during the 2009 fiscal year.

The Work Plan identifies 20 areas of focus for hospitals, and includes many other initiatives which may impact hospitals, such as ambulatory services, physician services, laboratory services, nursing homes, home health, DME and prescription drugs.
 
The 2009 Work Plan contains many issues which have been of concern to OIG in the past, and also identifies several new priority areas which may directly impact hospitals, including:
 
1. Provider-Based Status for Inpatient & Outpatient Facilities: The OIG will review cost reports of hospitals claiming provider-based status to determine the potential impact on the Medicare program and its beneficiaries when hospitals improperly claim provider-based status for both inpatient and outpatient facilities.
 
 2. Billing for Hospital-Owned Physician Practices: The OIG will review the appropriateness of Medicare reimbursement to hospital-owned physician practices to determine the extent to which practices without provider-based designation are being improperly reimbursed at higher rates.
 
3. Quality of Care Data: Hospital control measures will be evaluated to ensure the accuracy of quality of care data that hospitals submit to CMS, which may impact reimbursement.
 
4. EMTALA Compliance: The OIG plans to review CMS’s oversight of hospitals’ compliance with the EMTALA, including methods for tracking complaints and cases, referring cases to the States, and making determinations about whether to terminate noncompliant providers from the Medicare program.
 
5. Medicare Payments for Unlisted Procedure Codes: The OIG plans to assess the accuracy of Medicare payments for services billed using procedure codes not listed in HCPCS.
 
6. Health Information Data Security and Privacy: The OIG plans to evaluate security controls implemented by hospitals to prevent the loss of protected health information stored on portable devices and media (laptops, jump drives, backup tapes), as well as hospital policies pertaining to electronic health information protections, access, storage and transport.
 
7. Payments for CPAP: The OIG will assess the appropriateness of Medicare Part B payments for continuous positive airway pressure devices to determine whether the payments were supported, billed and paid in accordance with Medicare requirements.
 
8. Medical Identity Theft in Medicare: The OIG will review activities designed by CMS to deter medical identity theft in Medicare through early detection and notification. This may also signify increased scrutiny by OIG of hospital information security systems.
 
9. Outpatient Physical Therapy Services: Outpatient physical therapy services will be reviewed to determine whether services were billed in accordance with Medicare reimbursement regulations that require such services to be reasonable, medically necessary and properly documented.
 
10. Capital Payments for Extraordinary Circumstances: Additional capital payments made to hospitals for extraordinary circumstances (e.g., a flood, a fire, or an earthquake) will be reviewed by the OIG to determine whether the payments were made in accordance with Federal requirements.
 
RECOMMENDED COMPLIANCE ACTIONS
 
The 2008 Work Plan provides an opportunity for your hospital’s compliance program to address new regulatory issues. We recommend the following actions:
 
1. Compliance Committee: Conduct a meeting of your hospital’s compliance committee to discuss the 2009 Work Plan, emphasizing new areas of OIG concern which your hospital has not yet reviewed. Keep written minutes of all meetings to document these efforts.
 
2. Audits: Initiate internal and/or external audits of hospital systems, policies and procedures which may be implicated by the 2009 Work Plan (particularly those that have not recently been audited by the hospital) to evaluate the hospital’s compliance in these areas. Document these efforts thoroughly by preparing a written summary of the methodology and results of such audits, including any corrective actions.
 
3. Risk Areas: If your compliance program sets forth risk or audit areas, amend it to add new risk areas from the 2009 Work Plan.
 
4. Dissemination to Management: Send copies of the 2009 Work Plan to the hospital’s management and board, as appropriate, with a memo explaining its significance; or send selected segments of the Work Plan to hospital managers based on their area of responsibility. Keep copies of all such memos distributed to hospital management.
 
5. In-Service Hospital Personnel: Conduct seminars for hospital personnel - - targeted to their service areas - - to familiarize them with applicable areas of the 2009 Work Plan, and document all such efforts.
 
6. Copies to Physicians: Send copies of the 2009 Work Plan, or select portions which are relevant to physicians (such as pages 13-17), to all physicians on the medical staff along with a letter explaining its significance. Keep copies of all such communications.
 
7. Seminars for Physicians: Offer a seminar to physicians about the specific areas identified by the OIG which are relevant to physicians and their practices, and document all such efforts.
 
8. Compliance Training: Modify your hospital’s annual compliance training to add references to the 2009 Work Plan, highlighting areas which are of particular relevance to your hospital. Document all such changes.

© Sills Cummis & Gross P.C.