OIG Issues Work Plan for FY2017

By | Published On: January 26, 2017

 Each year the U.S. Department of Health and Human Services (HHS), Office of the Inspector General (OIG) releases a Work Plan for the upcoming fiscal year. The Work Plan summarizes new and ongoing reviews and activities that the OIG plans to pursue with respect to HHS programs and operations during the current fiscal year and beyond. Some of the projects described in the Work Plan are statutorily required and others relate to risk areas identified by the OIG.

The OIG released its Work Plan for FY2017.[1] Along with reviewing reports and activities from the past year, the Work Plan included the following new and on-going activities likely to be of interest to community behavioral health organizations (CBHOs):

  • Inpatient psychiatric facility outlier payments (new): OIG will determine whether Inpatient Psychiatric Facilities nationwide complied with Medicare documentation, coverage, and coding requirements for stays that resulted in outlier payments.
  • State protocols for the use and monitoring of psychotropic medications for children in foster care (on-going): OIG will describe state protocols for the appropriate use and monitoring of psychotropic medications for children in foster care. For selected states, OIG will determine whether a sample of children in foster care enrolled in Medicaid received psychotropic medications in accordance with the state protocols. OIG will determine the extent to which the Administration for Children and Families ensures that children in foster care receive psychotropic drugs in accordance with States’ protocols.
  • Controls over opioid treatment programs (on-going):  SAMHSA funds State agencies’ Opioid Treatment Programs through its Substance Abuse Prevention and Treatment Block Grant.  OIG will determine whether State agencies effectively monitor Opioid Treatment Programs’ services and medications in accordance with the Federal Guidelines for Opioid Treatment Programs established under 42 C.F.R. Part 8.  OIG will ensure that program expenditures are allowable in accordance with Federal requirements outlined in 45 C.F.R. Part 75.
  • Medicaid review of provider payment suspensions during pending investigations of credible fraud allegations (on-going):  OIG will review the use of payment suspensions as a program integrity tool by states.  Federal financial participation in Medicaid is not available for items or services furnished by an individual or entity when there is a credible allegation of fraud. Upon a determination that allegations of fraud are credible, the state must suspend all Medicaid payments to the providers unless there is good cause to not suspend payments or to suspend only partial payment.

[1] The Work Plan is available at https://oig.hhs.gov/reports-and-publications/workplan/.

Ms. Pledgie is a member of the New York and Massachusetts Bars and is not licensed in Washington, DC. Her practice is limited to federal health care matters.