Recent Additions to OIG Work Plan

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

These items have been added to the OIG work plan this month (August):

“Understanding skilled nursing facilities’ (SNFs’) costs is crucial to understanding the factors that contribute to nursing home performance and how nursing homes deliver care to beneficiaries. The cost of services, facilities, and supplies furnished to a provider by an organization related to the provider by common ownership or control may be included in the allowable cost of the provider in an amount equal to the related organization’s cost. However, such cost must not exceed the price of comparable services, facilities, and supplies that could be purchased elsewhere. Medicare requires that a reported amount be the lower of either the actual cost to the related organization or the market price for comparable services, facilities, or supplies, thereby removing any incentive to realize profits through these transactions. We will determine whether SNFs are reporting related-party costs in accordance with Federal regulations. We will also determine whether a SNF’s allocation of Medicare funds could impact beneficiary care, such as whether overhead costs might have increased while allocations for patient care decreased, potentially reducing care.”   This information is found here.

“The Coronavirus Aid, Relief, and Economic Security Act created the Pandemic Response Accountability Committee (PRAC). PRAC’s mission is to promote transparency and support coordinated oversight of the Federal Government’s COVID-19 response in order to prevent and detect fraud, waste, abuse, and mismanagement, and to mitigate major risks that cross program and agency boundaries. PRAC members include Offices of Inspectors General (OIGs) at Federal agencies, some of which operate, utilize, or are otherwise impacted by health care programs. Within PRAC, a Health Subgroup has identified health care personnel as a resource critical to the Federal Government’s COVID-19 response efforts. HHSOIG will work with PRAC to produce a report that describes health care personnel shortages in Federal, health-related programs operated or overseen by various Federal agencies and summarize best practices for hiring and retaining health care personnel for possible implementation. This project will involve coordinating with OIGs from multiple agencies. HHS-OIG will focus on personnel shortages at nursing homes.”  This information is found here.

The list of all August additions to the Work Plan can be viewed here.