This review of the OIG FY2016 Work Plan will provide the various section(s) that were identified by the OIG that may affect Emergency Medicine and Ambulance Services. It does not include a comprehensive review of all components of the Work Plan. This document is for “informational use only” and it is not intended to provide legal advice or counseling on the various topic(s). If the reader has concerns or questions they should consult with their legal counsel for advice.
The OIG released its Fiscal Year 2016 (FY2016) Work Plan on Oct. 30, 2015. The OIG Work Plan sets forth various projects to be addressed during the fiscal year by the Office of Audit Services, Office of Evaluation and Inspections, Office of Investigations, and Office of Counsel to the Inspector General. The Work Plan includes projects planned in each of the Department's major entities: the Centers for Medicare & Medicaid Services (CMS); the public health agencies; the Administrations for Children & Families; and Administration on Aging. The OIG Work Plan is published annually to describe the investigative, enforcement and compliance activities that it will undertake in the coming year. Many of the initiatives are carried over from the prior year’s Work Plan as “ongoing,” however there are several new initiatives for FY2016.
The OIG Work Plan outlines the current focus areas and states the primary objectives of each project. The word “New” after a project title indicates the project did not appear in the previous Work Plan. At the end of each project description, the OIG provides the internal identification code for the review (if a number has been assigned), the year in which they expect one or more reports to be issued as a result of the review, and whether the work was in progress at the start of the fiscal year or is planned as a new start. Typically, a review designated as “work in progress” will result in reports issued in FY 2016, but a review designated as “new start,” meaning it is slated to begin in FY 2016, could result in an FY 2016 or FY 2017 report, depending upon the time when the assignments are initiated during the year and the complexity and scope of the examinations.
The items selected in this document contain only those that may pertain to Emergency Medicine and Ambulance services (directly or indirectly).
The OIG will update its online Work Plan if necessary and the updates can be found at: www.oig.hhs.gov
Once again the OIG focuses on prevention of fraud, waste and abuse in various programs associated with the healthcare sector. It also focused on implementing regulations associated with the 2010 Patient Protection and Affordable Care Act that are roll over items from previous years’ Work Plans. The OIG’s main scrutiny is identifying problematic payments both before they are paid; as well as identifying post-review payment problems. There are several initiatives focused on review of the CMS contractors (i.e., Medicare Administrative Contractor [MAC]) and whether they are meeting their contractual expectations to identify, prevent and capture inappropriate payments to providers and suppliers.