OIG's 2016 Work Plan targets Part D, med equipment fraud concerns
Medicare Part D pharmacy enrollment, drug reimbursement and durable medical equipment are among the new fraud and abuse focus areas targeted by the Office of Inspector General (OIG), according to agency's 2016 Work Plan.
The OIG added two new focus areas to its ongoing efforts that are concerned with Part D sponsor compliance. The agency expects to issue reports in 2017 that will review the way pharmacies determine beneficiary eligibility in the Part D program, as well as the Centers for Medicare & Medicaid Services' ability to regulate pharmacies that bill for high-risk drugs.
Part D fraud has been a focal point for OIG, and legislators are concerned that the program is vulnerable to improper payments. In July, senior OIG officials testified about Part D fraud and abuse before the House Subcommittee on Oversight and Investigations following the release of two reports highlighting potential weaknesses within the program. The OIG also plans to target specialty drugs, which comes as no surprise since specialty pharmacies have been called into question after a number of high-profile settlements.
The OIG will also review Part B claims for orthotic braces to evaluate medical necessity, along with physicians referring those services. Fraudsters have been known to target seniors in an effort to bill Medicare for unnecessary back braces. The agency will also review Medicare payments to incarcerated beneficiaries.
Additionally, the work plan included revisions to existing focus areas surrounding state enforcement actions, including Medicaid drug utilization reviews, screening providers for Medicaid enrollment and provider suspensions based on credible allegations of fraud. Those reports are expected to be released in 2016.
The OIG will continue its work targeting managed care plans, including Medicare Advantage, which have come under fire this year regarding beneficiary risk scores. A report on reasonable and necessary chiropractic services is also due in 2016, following last month's report that identified $76 million in questionable claims tied to chiropractic services.
For more:
- read the OIG's 2016 Work Plan
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OIG reports revisit questionable billing and fraud within Medicare Part D
OIG identifies $76 million in questionable chiropractic claims
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