2008 OIG Work Plan Released: Several Therapy-Related Items Identified
The Department of Health and Human Services (HHS), Office of Inspector General (OIG) has published its fiscal work plan for 2008. The work plan describes problem areas for improvement and vulnerabilities within several HHS agencies that the OIG has identified as necessary to improve overall efficiency and effectiveness.
During the next fiscal year, the OIG plans to review several areas of investigation for the Centers for Medicare & Medicaid Services (CMS). Some of the key areas related to occupational therapy include appropriateness of Medicaid payments for therapy services, Medicare “incident to“ services, payments for power wheelchairs, Durable Medical Equipment (DME) in nursing homes, therapy payments to home health beneficiaries, and therapy services provided by Comprehensive Outpatient Rehabilitation Facilities (CORFs).
The OIG will begin a new review of Medicaid payments for occupational therapy services to ensure that services are billed correctly, medically necessary, and provided by qualified providers. The review will identify occupational therapy services provided under Medicaid and will compare it to Medicare and its program integrity.
For therapy services provided under a Medicare Part B setting, the OIG intends to review Medicare Part B therapy services furnished to beneficiaries in home health episodes under the home health prospective payment system and those under arrangements from outside suppliers. The OIG will also continue to review and analyze occupational therapy issues related to “incident to” services, documentation, medical necessity, and proper physician certification. Therapy services provided by CORFs will also be studied. Prior reviews have shown that Medicare has paid significant amounts for unallowable or questionable services that were not reasonable and necessary.
In the area of payments for power wheelchairs, the OIG will continue to examine documentation and evidence on claims submitted by providers for power wheelchairs to determine whether Medicare beneficiaries received face-to-face examinations before receiving their power wheelchairs. Additionally, DME payments allowed for items or supplies in nursing homes to Medicare Part B beneficiaries’ were previously found to be inappropriately reimbursed for services other than skilled nursing care and rehabilitation services. The OIG will continue to monitor Medicare suppliers and contractors on both issues to ensure proper payments.
The 2008 work plan is available for review on the HHS OIG Web site at http://oig.hhs.gov/publications/docs/workplan/2008/Work_Plan_FY_2008.pdf