OIG Cites Medicare, Medicaid Among Top Unimplemented Recommendations

CMS has failed to implement many of the policy changes recommended to it by HHS’s Office of the Inspector General, according to a new OIG report.

Every year the Department of Health and Human Services’ OIG offers recommendations for policy changes designed to reduce fraud, waste, and abuse in HHS programs.  This week, the OIG published “OIG’s Top Unimplemented Recommendations:  Solutions to Reduce Fraud, Waste, and Abuse in HHS Programs.”

Among the top 25 unimplemented recommendations to the Centers for Medicare & Medicaid Services are 14 involving Medicare and Medicaid.  Its top 10 unimplemented Medicare recommendations are:

  1. CMS should take actions to ensure that incidents of potential abuse or neglect of Medicare beneficiaries are identified and reported.
  2. CMS should reevaluate the inpatient rehabilitation facility payment system, which could include seeking legislative authority to make any changes necessary to more closely align inpatient rehabilitation facility payment rates and costs.
  3. CMS should seek legislative authority to comprehensively reform the hospital wage index sy
  4. CMS should seek legislative authority to implement least costly alternative policies for Part B drugs under appropriate circumstances.
  5. CMS should provide consumers with additional information about hospices’ performance via Hospice Compare.
  6. CMS should continue to work with the Accredited Standards Committee X12 to ensure that medical device-specific information is included on claim forms and require hospitals to use certain condition codes for reporting device replacement procedures.
  7. CMS should analyze the potential impacts of counting time spent as an outpatient toward the 3-night requirement for skilled nursing facility (SNF) services so that beneficiaries receiving similar hospital care have similar access to these services.
  8. CMS should provide targeted oversight of Medicare Advantage organizations (MAOs) that had risk-adjusted payments resulting from unlinked chart reviews for beneficiaries who had no service records in the 2016 encounter data.
  9. CMS should require MAOs to submit ordering and referring provider identifiers for applicable records in the encounter data.
  10. CMS should develop and execute a strategy to ensure that Part D does not pay for drugs that should be covered by the Part A hospice b

The OIG’s top four unimplemented recommendations addressing Medicaid are:

  1. CMS should ensure that States’ reporting of national Medicaid data is complete, accurate, and
  1. CMS should collaborate with partners to develop strategies for improving rates of followup care for children treated for attention deficit hyperactivity disorder (ADHD).
  2. CMS should develop policies and procedures to improve the timeliness of recovering Medicaid overpayments and recover uncollected amounts identified by OIG’s audits
  3. CMS should identify States that have limited availability of behavioral health services and develop strategies and share information to ensure that Medicaid managed care enrollees have timely access to these services.

Learn more about these and other recommendations, and the challenges they seek to address, in the Department of Health and Human Services Office of the Inspector General Report OIG’s Top Unimplemented Recommendations:  Solutions to Reduce Fraud, Waste, and Abuse in HHS Programs.

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