OIG Updated 2017 Work Plan

Today, OIG-HHS updated its 2017 Work Plan by adding several new work items, which, among other items, included reviews of quality data reported by ACOs and deficiencies noted in surveys of hospices, and excessive spending on opioids in Part D and its perceived correlation to the opioid epidemic in the U.S. It is anticipated that OIG will continue to update its Work Plan as future issues arise. 

ACOs

To demonstrate that they are providing appropriate, high-quality care while reducing costs, ACOs are required to report complete and accurate data on quality measures and to satisfy minimum levels of certain quality measures as set by CMS. CMS assesses an ACO’s overall quality performance by calculating a single quality performance score across all quality measures reported by the ACO. This score is used in part to calculate the ACO’s earned shared savings. We will review MSSP ACOs that received earned shared savings payments to determine whether they reported quality measures data in accordance with Federal requirements. Our review is part of several OIG reviews that will examine various aspects of the ACOs under the MSSP.

https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000224.asp

Hospices

These surveys assess the extent to which hospices meet Federal health and safety standards and require that surveyors cite hospices with deficiencies if they fail to meet the standards. Previous OIG reports identified numerous vulnerabilities and raised concerns about the limited enforcement actions against poorly performing hospices. As part of OIG’s ongoing commitment to address quality of care, we will determine the extent and nature of hospice deficiencies and complaints and identify trends.

https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000211.asp 

Opioid Abuse

 Previous OIG work called attention to increased Part D spending for commonly abused opioids. OIG has also highlighted the problem of drug diversion—the redirection of prescription drugs for an illegal purpose, such as recreational use or resale. This data brief builds on OIG’s previous work and includes in-depth analysis of opioid utilization among Medicare Part D beneficiaries. It provides baseline data on the extent to which beneficiaries are receiving extreme amounts of opioids and appear to be doctor shopping. It also identifies prescribers who have questionable opioid prescribing patterns.

https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000207.asp