OIG to Investigate Hospital Payments in 2013

Affordable Care Act

In addition to the office's many other projects, 29 deal with implementation of the 2010 healthcare reform laws, including eight labeled as new projects for 2013.

They include

• A review of federal grants to states to establish insurance exchanges with an eye to assure that the exchanges prevent fraud, waste, and abuse.

• Two reviews will look into the creation of Consumer Operated and Oriented Plans, or CO-OPs. One involves an investigation of the process CMS uses to select recipients of $3.4 billion in new funding for CO-OPs. These funds go to organizations vying to be qualified nonprofit health insurance issuers, and help get loans to pay their startup costs and meet state solvency requirements.

• The OIG will look at whether home health agencies are complying with a requirement that physicians who certify Medicare beneficiaries as eligible for home health services actually have face-to face encounters with them.

• The OIG will examine whether Medicare payments for power mobility devices, such as wheelchairs, meet requirements and "whether savings can be achieved by Medicare for rentals rather than lump-sum purchase for certain" devices.

• The office will determine how frequently Medicare officials should make onsite visits to providers and suppliers identified by CMS as moderate or high risk for fraud.

• The office will review the extent to which state Health Insurance Assistance Programs (SHIPs) provide Medicare with fraud information. Special funding for fraud detection was provided to SHIPs for this purpose.

• Officials will review state Medicaid agencies' processes for enrolling and monitoring medical equipment suppliers. "In a recent OIG report on Medicaid suppliers, more than 15% of the suppliers failed to meet at least one enrollment standard."