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What another crazy year, huh?! In 2021, the OIG continued to publish its work plan with monthly updates including OIG audits and evaluations for the fiscal year and beyond. Although the COVID-19 pandemic continues on, healthcare operations and government oversight entities such as the OIG continue their work. As of the end of November 2021, the OIG had published 12 new issues during the month of November.

Yet emergency waivers and flexibilities have kept our eyes on the immediate public health emergencies. When the waivers finally end, what will the world of healthcare compliance enforcement look like?

It’s important to not let our compliance efforts lax as the OIG continues to publish new items and revise many that have been planned for several years. We are tasked with monitoring our operations to guarantee an effective compliance program. One key method is to monitor potential risk areas published by the OIG. Paying attention to what the OIG for Health and Human Services (HHS) plans to audit and monitor during the upcoming year should be a one of the key drivers in developing your own annual audit plan.

Although the OIG no longer publishes out an annual work plan, you can still prepare your organization’s compliance work plan as was done in the past. However, this year, as the pandemic continues to affect our operations and even our compliance work plan effectiveness you may approach it a bit differently. One approach is to go to the OIG work plan and look at the items that have been added since the public health emergency began. You can then sort through them for the applicable items related to your organization’s services. Although the plan is specific to what the OIG plans to audit in respect to HHS programs, it provides a plan of the audits that organizations may experience as well. The OIG items covers Medicare, Medicaid, FDA, Substance Abuse/Mental Health, Public Health, Indian Health Services and Other.

After reviewing the OIG items, you may consider some questions related to your 2022 compliance work plan including:

  • Has the public health emergency (PHE) resulted in items to add to your plan?
  • Due to the PHE, will you be narrowing the focus of you plan? Or expanding your plan?
  • Were there items you deferred during 2021?

Some of the most notable recent and active OIG work plan items include:

Telehealth Services

  • In October 2020, CMS announced the plan to begin auditing Medicare Telehealth Services. The item was revised and expected to occur in 2022. CMS has implemented a number of waivers and flexibilities that allowed Medicare beneficiaries to access telehealth services. Medicare Part B and C data will be reviewed for program integrity risks associated with telehealth services during the pandemic. OIG will analyze provider billing patterns. Although there isn’t a lot of detail, you should continue to watch for updates and review once the initial audit is published.
  • OIG will also be reviewing Medicaid Telehealth for oversight of state agencies and waivers that occurred during the PHE. This item was also revised from 2020 and expected in 2022.
  • OIG will also focus on selected States use of telehealth in behavioral health services. It will analyze how these States and managed care organizations (MCOs) use telehealth to provide behavioral healthcare. It will also review selected States’ monitoring and oversight of MCOs’ behavioral health services provided via telehealth.

Pain Audits

  • OIG has revised its focus on several pain management audits including facet joint injections, facet join denervation sessions, lumbar epidural injections and trigger point injections under Medicare Part B. Providers should review their services and documentation to ensure compliance with federal requirements. In 2022, OIG will issue a report on provider compliance.

Two-Midnight Rule for Inpatient Admissions

  • OIG announced a revised plan to begin auditing short stay claims in 2022 related to the implementation of the Two-Midnight Rule in Fiscal Year 2014. Under this rule, it is generally considered inappropriate to receive payment for stays not expected to span at least two midnights. OIG will begin auditing short stay claims and recommending overpayment collections.

Other key items to look at for 2022 include payments for clinical diagnostic laboratory tests, waiving or reducing co-payments under telehealth policy, infection control items related to guidance in some areas, Medicaid provider enrollment, COVID inpatient discharges, cybersecurity review of HHS, review of CARES Act, Provider Relief Funds, emergency preparedness and other long standing OIG audit areas.

No matter when an organization reviews the OIG Work Plan, this resource is important in creating an annual audit plan and educating leadership on ongoing OIG activities.

Written by Aurae Beidler, MHA, RHIA, CHC, CHPS