The Office of Inspector General 2014 Work Plan: home health and hospice

The United States Department of Health and Human Services (HHS) Office of the Inspector General (OIG) Work Plan for Fiscal Year 2014 summarizes ongoing reviews and activities that the OIG plans to pursue with respect to HHS programs and operations during the next fiscal year and beyond. 

The focus for the 2014 plan related to home health includes:

Medicare Program

1.      Home Health prospective payment system requirements:  Billing and Payments

The OIG plan includes a continued review of the documentation required in support of claims paid by Medicare and if claims were paid in accordance with Federal laws and regulations.

2.      Employment of individuals with criminal convictions: Quality of Care and Safety

The OIG plan includes a review to determine the extent to which home health agencies are complying with the state requirements for conducting criminal background checks on home health agency applicants and employees.

Medicaid Program

1.      Home health services: provider and beneficiary eligibility

The OIG plan includes a review of home health agency claims to state Medicaid programs to determine whether the billing providers met applicable criteria to provide home health services to Medicaid beneficiaries.

2.      Home health services: Screenings of health care workers

The OIG plan will include a review of health-screening records of Medicaid home health agency health care workers to determine whether they were screened in accordance with Federal and State requirements.

 The focus for the 2014 plan related to hospice includes:

1.      Hospice in assisted living facilities

The OIG plans a review of the extent to which hospices serve Medicare beneficiaries who reside in assisted living facilities. The review will determine length of stay, levels of care received and common terminal illnesses of beneficiaries who receive hospice care in assisted living facilities.

2.      Hospice  general inpatient care

The OIG plan will include a review of the use of hospice general inpatient care.  The review will include an assessment of the appropriateness of hospices’ general inpatient care claims and the content of election statements for hospice beneficiaries who receive general inpatient care and a review of the medical records to address concerns that this level of hospice care is being misused.

For more information and a copy of the full OIG work plan go to OIG work plan 2014.

 Until next time,

M

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