OIG Work Report includes plans for O&P claims

The Department of Health and Human Services Office of Inspector General has released its Work Plan for fiscal year 2015.

The plan summarizes the new and ongoing reviews and activities the Office of Inspector General will pursue with respect to the Department of Health and Human Services programs and operations. The majority of Office of Inspector General (OIG) funding is directed toward the oversight of Medicare and Medicaid programs.

According to the report, the OIG will address quality of care in O&P, “including beneficiary access to durable medical equipment, prosthetics, orthotics and supplies in the context of new programs involving competitive bidding.” Additionally, OIG will review CMS’s competitive bidding process and “make subsequent pricing determinations for certain medical equipment items and services in selected competitive bidding areas under rounds 1 and 2 of the competitive bidding program.”

The report’s section on lower limb prosthetics states that OIG will continue to review Medicare Part B payments for claims submitted for reimbursement for lower limb prostheses, to determine whether the devices meet CMS requirements. According to the report, “A national OIG review of suppliers of lower limb prosthetics identified 267 suppliers that had questionable billing. Earlier OIG work found that suppliers frequently submitted claims that did not meet certain Medicare requirements; were for beneficiaries with no claims from their referring physicians; and had other questionable billing characteristics.” The report states that Medicare will not reimburse suppliers for items or services it does not consider reasonable and necessary.

OIG will periodically update the Work Plan, which can be found at http://oig.hhs.gov/.

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