OIG focus on Medicaid

This is the second post on the OIG’s FY 2013 work plan. The first post dealt with Medicare-related issues. This post looks at HHA focuses for Medicaid issues. Note that some have a FY2014 start date. This can indicate a new focus on an item that is already being watched by OIG.

Duplicate Payments by Medicare and Medicaid: OIG will review Medicaid payments by states for Medicare-covered home health services to determine the extent to which both Medicare and Medicaid have paid for the same services. (OAS; W-00-13-31305; various reviews; expected issue date: FY 2014; new start)

Screenings of Health Care Workers: OIG will review health-screening records of Medicaid home health care workers to determine whether the workers were screened in accordance with federal and state requirements. Examples of health screenings can include vaccinations for hepatitis and influenza. (OAS; W-00-11-31387; W-00-12-31387; various reviews; expected issue date: FY 2013; work in progress.

Provider Compliance and Beneficiary Eligibility: OIG will review HHA claims to determine whether providers have met applicable criteria to provide services and whether beneficiaries have met eligibility criteria. Providers must meet criteria, such as minimum number of professional staff, proper licensing and certification, review of service plans of care, and proper authorization and documentation of provided services. (OAS; W-00-10-31304; W-00-11-31304; W-00-12-31304; various reviews; expected issue date: FY 2013; work in progress)

Homebound Requirements: OIG will review CMS policies and practices for reviewing the sections of Medicaid State plans related to eligibility for home health services and describe how CMS intends to enforce compliance with appropriate eligibility requirements for home health services. The office will also identify the number of states that violate federal regulations by inappropriately restricting eligibility for home health services to homebound recipients. (OEI; 00-00-00000; expected issue date: FY 2014; new start)

Read the entire OIG report

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