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The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently added four updates to its Active Work Plan (Work Plan) for December.  The OIG began releasing its Work Plan projects on an ongoing basis in 2017, as opposed to providing biannual updates.  A monthly update schedule ensures that the Work Plan closely aligns with the OIG’s work planning process.  Work Plan items are selected based on relative risks in HHS programs and operations to identify those areas most in need of attention.  The OIG considers several factors when creating Work Plan items, including legal mandates, congressional requests, budgetary concerns, potential for positive impact, and others.

The December additions to the OIG Work Plan include the following:

1. Data Brief: Early Results from the Opioid State Targeted Response Grants

The Substance Abuse and Mental Health Services Administration (SAMHSA) awards and oversees $1 billion in Opioid State Targeted Response (Opioid STR) grants authorized under the 21st Century Cures Act.  The grants are used to, “address the opioid crisis by increasing access to treatment, reducing unmet treatment need, and reducing opioid overdose related deaths through the provision of prevention, treatment, and recovery activities for opioid use disorder.”  The majority of the grant funds must be used for opioid treatment services that use clinically-appropriate and evidence-based practices, particularly services that use medication-assisted treatment (MAT).  The Office of Evaluation and Inspections (OEI) will conduct a review of the early results of the Opioid STR grants, focusing on states’ use of grant funds in the first year of the program.  The review will describe populations the Opioid STR grants reached and the extent that MAT was included in grant-funded treatment.

2. Assessing Inpatient Hospital Billing for Medicare Beneficiaries

The Centers for Medicare & Medicaid Services and the OIG have identified problems with hospitals upcoding, the practice of mis-coding or over-coding in the billing for services to increase payment.  The OEI will conduct a two-part review to assess inpatient hospital billing practices.  First, the OEI will analyze Medicare claims data to provide landscape information about hospital billing, specifically billing variation across hospitals and changes in hospital inpatient billing over time.  The second review will take the results from the first review and target certain hospitals and codes for a medical review to determine the extent that hospitals billed incorrect codes.

3. State Compliance with FFS and MCO Provider Enrollment Requirements

The OEI will conduct a survey study mandated by the 21st Century Cures Act of state Medicaid agencies on enrollment of fee-for-service (FFS) and Managed Care Organization (MCO) providers, as well as the implementation of required provider enrollment screening.  The 21st Century Cures Act requires states to enroll all Medicaid providers in both Medicaid FFS and MCOs.  Medicaid enrollment is a program integrity tool used to protect the Medicaid program from fraud and abuse.

4. T-MSIS Data Assessment: Usefulness of National Data to Monitor Opioid Prescribing in Medicaid

Transformed Medicaid Statistical Information System (T-MSIS) data can be used as a national dataset to help Medicaid manage critical issues, such as the opioid crisis.  States have submitted data, but the data is not necessarily complete, making it unusable as a national dataset.  The OEI will determine whether T-MSIS contains the necessary data to identify at-risk opioid prescription recipients through Medicaid, nationally.  The OEI will also interview states to assess challenges facing states in submitting the data necessary for identifying and preventing beneficiary harm from opioid misuse.

The OIG Work Plan is available at: https://oig.hhs.gov/reports-and-publications/workplan/index.asp.

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