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OIG to Investigate HIX Flaws in 2014

Cheryl Clark, for HealthLeaders Media, February 3, 2014

The federal government's latest efforts to identify and correct fraud, waste, and abuse within federally funded healthcare programs are outlined in the 2014 work plan issued by the Office of Inspector General.

What went wrong with the health insurance exchange rollout and HealthCare.gov, admission criteria under the so-called "two-midnight rule," and whether taxpayers should bear the brunt of unreasonable healthcare executive compensation, are among 60 new targets of investigation announced by the Office of Inspector General for the U.S. Department of Health and Human Services.

The OIG's 2014 work plan was issued Friday, nearly four months behind schedule. The annual list of investigations, inspections, and audits includes more than 140 other projects listed in previous years' work plans that are ongoing or planned.

All are part of the government's effort to correct fraud, waste, and abuse within federally funded healthcare programs. The scope of work covers Medicare, Medicaid, the Children's Health Insurance Program, the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration.

Richard Kusserow, who held the office of Inspector General for 11 years and is the founder and CEO of the consulting firm Strategic Management, says that a key area of interest for the OIG this year is the $4.8 billion in contracts overseen by the Centers for Medicare & Medicaid Services, including those companies who were contracted for the exchange rollout.

"There's been a lot of questions about contract administration at CMS," Kusserow said in an interview. "What this means is that maybe what they're [the OIG] going to look at is how well they're managing the process of hospital appeals specific to Recovery Audit Contractors [RAC] refusing claims. I think there's going to be a huge war on this issue."

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