OIG to Investigate Hospital Payments in 2013

Cheryl Clark, October 8, 2012

Federal health investigators say they are launching 112 new investigations as part of their 2013 work plan, 8 of which deal with programs authorized under the Patient Protection and Affordable Care Act.

The 148-page Office of Inspector General Work Plan 2013, issued annually by the Office of Inspector General for the U.S. Department of Health & Human Services, highlights 25 projects that examine the Centers for Medicare & Medicaid Services payment policies to hospitals under Part A and Part B, 11 of which are new.

Also included in the work plan is a program to expand the review of Recovery Audit Contractors from only working with Medicare providers to state Medicaid programs as well.

Payments for hospital transfers

The extent to which hospitals have miscoded transfers to another hospital for patients needing further care, which should be paid at a lower rate, will be examined.

A similar new project involves examining the appropriateness of payments to hospitals that transfer patients to a different hospital, which then places that patient in a "swing" bed, which can be used interchangeably for acute care or skilled nursing services.

Yet another project involves a re-evaluation of Medicare's current practice of paying hospitals a full Medicare DRG rate for patients with short lengths of stay who are transferred to a hospice. "Analysis of Medicare claims data demonstrates significant occurrences of a discharge from an acute care hospital after a short stay that is immediately followed by hospice care...If appropriate, we will recommend that CMS (the Centers for Medicare & Medicaid Services) evaluate its polity related to payment for hospital discharges to hospice facilities."


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