ACE Alert: The OIG Spring Report confirms that enforcement will continue

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The OIG Spring Report confirms that enforcement will continue.

The Spring Semiannual Report to Congress was released on June 6th and details the work the OIG is doing in regard to the HHS programs and operations. It covers the period of October 2021 through March 31, 2022, and they continue to report significant savings.

Of the highlights, they issued sixty-one audits and evaluations. They expect to recover $1.14 billion in expected audit recoveries and have listed $162 million in potential savings to government programs. They filed a total of 640 criminal and civil actions. There were 1,043 exclusions from the government programs during this timeframe.

A significant amount of work related to the COVID-19 Pandemic and the ease of restrictions on prior authorizations and early refill requirements for prescription drugs. To no one’s surprise, the OIG found that 84 percent of Medicare beneficiaries received telehealth services from providers with whom they had an established relationship. 

Preventing and Treating opioid misuse was also a top concern. A significant finding from the OIG’s work is quoted from the report:
            “OIG found that of the roughly 1 million Medicare beneficiaries diagnosed with opioid use disorder in 2020, less than 16 percent received medication to treat their opioid use disorder. Further raising concerns that beneficiaries face challenges accessing treatment, less than half of beneficiaries who Department of Health and Human Services, Office of Inspector General Semiannual Report to Congress—October 1, 2021, Through March 31, 2022, 10 received medication to treat opioid use disorder also received behavioral therapy. We also found that beneficiaries in Florida, Texas, Nevada, and Kansas were less likely to receive medication to treat their opioid use disorder than beneficiaries nationwide; that Asian/Pacific Islander, Hispanic, and Black beneficiaries were less likely to receive medication than White beneficiaries; and that older beneficiaries and those who did not receive the Part D low-income subsidy were also less likely to receive medication to treat their opioid use disorder. (See report OEI-02-20-00390.) “

There is no doubt that the OIG will continue to focus on unlawful drug distribution and pharmacy kickbacks that continue to make prescribing a high risk for our pain physicians.

The other interesting finding that applies to our pain providers was that the OIG found that more than 40% of health care providers did not comply with Medicare requirements when they billed for neurostimulator implantation surgeries. They estimated that in 2016 and 2017 providers received $636 million in unallowable Medicare payments associated with neurostimulator implantation surgeries and beneficiaries paid $54 million in related unnecessary co-pays and deductibles. (See report A-01-18-00500). So now you know why CMS has recently imposed a precertification process for stimulator services.

Yes, government enforcement is alive and busy as ever. To access the full report: go.usa.gov/xJBFh

Remember the best defense is an active compliance program. If you would like guidance, education or auditing for your program, please email us at aceadmin@aceauditors.com



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