The HHS OIG released its Work Plan for FY 2016 on November 2nd. The Work Plan outlines audits, evaluations, and other activities OIG is conducting or plans to conduct in the coming fiscal year. Much of the planned work for FY 2016 focuses on cut and dry payment reviews with the goal of identifying and reducing inappropriate payments. However, the work plan also includes evaluations of program implementation and oversight.
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OIG Program Evaluations
The health care program evaluations outlined in the OIG 2016 Work Plan include a few broad themes that can be expected in future evaluations. A summary of the evaluations is listed below:
- Evaluation of implementation: OIG plans to evaluate the status of CMS and States’ implementation of key health programs, including ICD-10 and enhanced and provider enrollment screening. OIG will determine the extent to which CMS and States have implemented these required programs and in some cases plans to evaluate the implementation process itself.
- Evaluation of internal controls: OIG plans to evaluate States’ internal controls for several health programs and Federal grants. For example, OIG currently has multiple reviews underway to determine whether States have established adequate internal controls for collecting Medicaid rebates on physician-administered drugs. Other reviews will assess States’ internal controls for monitoring the use of Federal funds.
- Evaluation of processes: OIG plans to assess CMS and state processes for implementing and administering health and payment programs. In multiple reviews, OIG will assess specific State processes to evaluate whether States have effective internal controls to ensure payment accuracy.
These evaluations do not promise large overpayments like many of the other reviews in the OIG Work Plan. However, they have the potential to save money before it is spent by identifying process inefficiencies and oversight vulnerabilities. IntegrityM offers expert evaluation services that can do the same for your organization.
We conduct government program evaluations that follow Blue Book Quality standards, work with program officials and staff to understand the inner workings of your program, and develop strategic plans to ensure regulatory compliance. For more information on our services and our evaluation methods, visit our Government Program Evaluation and Planning Services page.
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