The Office of the Inspector General's (OIG) 2014 work plan, released Jan. 31, includes an investigation of both provider and beneficiary eligibility for such care. In a project it began in 2013, OIG intends to examine the screening of caregivers to determine whether their screening satisfies state and federal requirements. Such screening involves vaccination against hepatitis (already required under the Labor Department's occupational safety and health rules) and influenza.
The OIG work plan also calls for scrutiny of standard home health services agencies who serve Medicaid beneficiaries. Medicaid providers of home health services must meet standards and conditions of participation that include a minimum number of skilled staff professionals and written plans of care that the referring physician reviews every 60 days. Both Medicare and Medicaid home health services must be intermittent, not full-time, and include skilled nursing. It also may include physical therapy or speech-language pathology services, the work plan notes.
Without providing details, the new work plan indicates OIG expanded the Medicare home health review it began last year. The work plan cites extensive home health fraud and says the question it wants to answer continues to be "whether home health claims were paid in accordance with federal laws and regulations."
If OIG finds evidence of fraud, it is likely based on past performance that it will to advise CMS to tighten payment rules affecting providers of home and community-based care.
In addition, an examination of hospice services for Medicare beneficiaries who live in assisted living facilities will occur to determine the length of stay, levels of care provided and common terminal illnesses. This will help CMS to meet the ACA requirement to reform the hospice payment system and collect the data needed to do so.
Read OIG's work plan here.