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Recent Industry News

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently issued six updates to its OIG Active Work Plan (Work Plan).  The Work Plan outlines ongoing and planned audits and evaluations for the fiscal year and beyond.  In 2017, the OIG began releasing its Work Plan projects on an ongoing basis, as opposed to providing biannual updates.  The monthly updates add new items and remove completed tasks from the Work Plan.  A monthly update schedule ensures that the Work Plan closely aligns with the OIG’s work planning process.

The OIG assesses 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.  In addition to working on projects that often lead to audits, reviews, and reports, the OIG also engages in a number of legal and investigative activities that are separately reported.

April 2018 additions to the OIG Work Plan include the following:

1.      Ensuring Dual-Eligible Beneficiaries’ Access to Drugs Under Part D: Mandatory Review.

  • The OIG will review the extent to which drug formularies developed by Part D sponsors include drugs commonly used by dual-eligible beneficiaries as required.  The Affordable Care Act (ACA) requires that the OIG conduct this review annually. This report will constitute the OIG’s eighth issued report on the topic.

2.      Review of Sole Incumbent Grantees’ Compliance with Head Start Program Requirements.

  • The Office of Audit Services will conduct a review of sole applicant grantees that the Administration for Children and Families reselected as incumbent grantees for the Head Start Program.  The review will determine whether grantees complied with Head Start’s health, safety, and financial management requirements.

3.      HHS Email Policies and Practices.

  • The OIG is performing a review to determine whether HHS and its operating divisions have adequate controls for the use of personal email. The review is in response to a congressional request and will determine whether HHS has controls in place to: (1) restrict, in accordance with federal laws and regulations, the use of personal email to conduct government business; and (2) preserve all emails related to government activities.

4.      Medicaid Nursing Home Supplemental Payments.

  • Certain states benefit from a Centers for Medicare & Medicaid Services (CMS) approved nursing home supplemental payment program.  The program pays the difference between Medicare and Medicaid rates for nursing home services.  In some cases, local governments use intergovernmental transfers to fund the state’s share of the program.  Previous OIG and Government Accountability Office (GAO) audits have found that federal supplemental payments have often benefited state and local governments more than they have benefited nursing homes themselves.  As such, the OIG will review the nursing home supplemental payment program’s flow of funding in order to determine how funds are being used.

5.      CMS Medicare Overpayment Recoveries Related to Recommendations in

         OIG Audit Reports.

  • HHS is responsible for resolving federal audit report recommendations related to its activities, grantees, and contractors within six months after formal receipt of the audit reports.  In its previous audit examining CMS’s overpayment recoveries, OIG recommended that CMS: (1) enhance its system and procedures for recording, collecting, and reporting overpayments; and (2) provide guidance to contractors on how to document overpayment collections.  The Office of Audit Services will conduct a review to determine the extent to which CMS: (1) collected agreed upon Medicare overpayments identified in previous OIG audit reports; and (2) took corrective action in response to the OIG’s recommendations in its prior audit examining overpayment recoveries.

6.       Review of Refugee Cash and Medical Assistance Payments.

  • The Refugee Resettlement Program (RRP) reimburses states for the cost that they would normally incur to provide refugees cash and medical assistance under existing federal and state assistance programs.  Refugee Cash Assistance (RCA) and Refugee Medical Assistance (RMA) grants are available to refugees for a limited time following their entry into the United States and are only available after a refugee fails to qualify for cash assistance or health benefits under Medicaid.  In fiscal year 2015, the Office of Refugee Resettlement (ORR) obligated $286 million to states for the RRP program.  The OIG will determine whether RCA/RMA payments to beneficiaries made by the state agency or a replacement designee, as applicable, were allowable in accordance with federal guidelines.

The OIG Work Plan is available at:

https://oig.hhs.gov/reports-and-publications/workplan/index.asp