What the OIG's 2016 work plan means for hospitals

A new federal work plan shows a growing shift in the Department of Health and Human Services' Office of Inspector General (OIG) priorities, particularly with regard to hospitals.

Instead of new hospital projects, the OIG will aim to complete in 2016 those already in progress, according to an analysis by Sara Lord, an attorney with the law firm Arnall Golden Gregory in Georgia, who used to work with the Department of Justice. 

In the next fiscal year, the OIG will sharpen its focus on reforming healthcare delivery and improving alternative care models and value-based purchasing, with a mandate focusing on cutting care costs and averting duplicate payments.

The only new hospital projects announced in the work plan are payment-focused, including a review of Medicare payments to acute care hospitals and an analysis of the Centers for Medicare & Medicaid Services' validation of inpatient quality reporting data. The plan also increases focus on fraud and abuse detection within Medicare Part D and drug reimbursement, FierceHealthPayer: AntiFraud previously reported.

Most projects included in the plan build on previous plans, with several focusing specifically on outcomes and care quality, including:

  • Developing an estimate for national rates of adverse and temporary harm events involving Medicare patients receiving post-acute care at rehabilitation centers
  • Developing similar estimates of harm events in long-term care hospitals as well as contributing factors and associated costs
  • Assessing hospitals' readiness for high-risk infectious diseases, in keeping with its previous analysis of threats such as pandemics and national disaster preparedness

"While the relative lack of new hospital-focused projects is interesting, it is also clear that the OIG will complete and publish a considerable number of reports concerning hospitals in 2016," Lord wrote in her analysis. "Since the OIG's findings in these reports often furnish the bases for further government investigation, hospitals should prepare for, and expect, continuing scrutiny in these areas."

To learn more:
- read the work plan (.pdf)
- here's the analysis (.pdf)

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