Office of the Inspector General of HHS (“OIG”) released its Compendium of Priority Recommendations, which includes 25 recommendations that OIG has made in previous audit and evaluation reports but have not yet implemented.  The recommendations are focused both on monetary savings and quality improvement, and span seven main areas, including Medicare and Medicaid Policies and Payments and Quality of Care and Safety Issues.

OIG intentions of note include:

  • Seeking legislation that would allow CMS to establish lower payment rates for lab tests.
  • Seeking legislative authority to remove necessary provider critical access hospitals (“CAHs”) permanent exemption from the distance requirement, allowing CMS to reassess these CAHs under the distance requirement.
  • Expanding the DRG window to include additional days prior to the inpatient admission, and expanding the DRG window to include other hospital ownership arrangements, such as affiliated hospital groups
  • Increasing scrutiny of claims submitted by community mental health services, home health services, and skilled nursing facilities.

Throughout the report there is a strong theme of increasing funding and resources for monitoring fraud and abuse and maximizing the recovery of Medicare and Medicaid overpayments.

The full report can be found here.

Leave a Reply

Your email address will not be published. Required fields are marked *