Mid-Year Fiscal Updates that will Surely Affect Healthcare Outsourcing

The U.S. Department of Health and Human Services Office of Inspector General just released the mid-year update for the fiscal year work plan for 2016. It laid out some important information that will be useful in predicting the direction of several undergoing and planned legal and investigative initiatives. Some of the note-worthy contend of the mid-year update that might affect healthcare outsourcing are the following:

Outpatient Outlier Payments for Short-Stay Claims
Office of the Inspector General will start to determine the extent of potential Medicare saving in cases wherein hospital stays were ineligible for an outlier patient. The purpose of the outlier payment is to ensure beneficiary access to services by having the Medicare program share in the financial loss incurred by a provider associated with individual, extraordinarily expensive cases. Prior OIG reports have concluded that a hospital’s high charges, unrelated to cost, lead to excessive inpatient outlier payments.

National Background Checks for Long-Term-Care Employees
The Office of the Inspector General will also review the procedures implemented by participating states for long-term-care facilities or providers to conduct background checks on prospective employees and providers who would have direct access to patients and determine the costs of conducting background checks. These analyses will determine the outcomes of the states’ programs and determine whether the background checks led to any unforeseen consequences. This mandated work is expected to be issued in fiscal year 2019, in accordance with section 6201 of the Affordable Care Act.

Medicare Home Health Fraud Indicators
The Office of the Inspector General will describe the extent that potential indicators associated with home health fraud are present in home health billing for 2014 and 2015. They will analyze Medicare claims data to identify the prevalence of potential indicators of home health fraud. This will help prevent cases in which the Medicare home health benefit from being exploited leading to fraud, waste, and abuse. OIG has a wide portfolio of work involving home health fraud, waste, and abuse.

Oversight and Effectiveness of Medicaid Waivers
The Office of the Inspector General will determine the extent to which selected states made use of Medicaid waivers and if costs associated with the waivers are efficient, economic, and do not inflate federal costs. Oversight of state Medicaid waivers will also be assessed. More states are using waivers to alter their Medicaid program in significant ways, and oversight of these programs presents challenges to ensure that payments made under the waivers are consistent with efficiency, economy, and quality of care. This initiative is expected to be issued in 2017.

Implementation of Recommendations Regarding HHS’ National Security Program
The Office of the Inspector General will assess whether applicable classification policies have been adopted, effectively administered, and followed, based on a 2013 report. The Reducing Over-Classification Act of 2010 requires that the Inspector General of each Federal department or agency with an officer or employee who is authorized to make original classification decisions conduct two evaluations. This mandatory review is expected to be issued in 2016.

There are also a handful of completed items in the OIC fiscal plan. Most of which are focused on Medicare as a result of the governments continue campaign for affordable healthcare.