The Work Plan of the Office of Inspector General (OlG) of the Department of Health and Human Services (HHS) lists projects to be addressed during the fiscal year. The plan includes projects planned in each of the Department’s major entities, including the Centers for Medicare and Medicaid Services (CMS).
The Work Plan for 2016 includes the following:
• Ambulatory surgery centers (ASCs): Quality oversight.
The OIG will review Medicare’s quality oversight of ASCs. Previous OIG work found problems with Medicare’s oversight system, including finding spans of five or more years between certification surveys for some ASCs, poor CMS oversight of state survey agencies and ASC accreditors, and little public information on the quality of ASCs.
• ASCs: Anesthesia services – non-covered services.
OIG will review Medicare Part B claims for anesthesia services to determine whether they were supported in accordance with Medicare requirements. “Specifically, we will review anesthesia services to determine whether the beneficiary had a related Medicare service,” the OIG said. Medicare will not pay for items or services that are not “reasonable and necessary.”
• Hospitals: Medical device credits for replaced medical devices.
The OIG will determine whether Medicare payments for replaced medical devices were made in accordance with Medicare requirements. Medical devices might require replacement because of defects, recalls, mechanical complication, etc. Federal regulations require reductions in Medicare payments for the replacement of implanted devices (42 CFR §§ 412.89 and 419.45). Prior OIG reviews have determined that Medicare administrative contractors have made improper payments to hospitals for outpatient and inpatient claims for replaced medical devices. (To access the entire work plan, go to http://1.usa.gov/1OfHdcz.)
