Senior HHS-OIG officials outlined agency goals in a video presentation entitled “OIG Outlook 2014.” In OIG Outlook 2014, HHS-OIG Inspector General Daniel Levinson described “a period of great transition in health care, as insurance marketplace models are introduced, and as payment models transition from volume to value-based. These transitions intend to produce higher quality of care at lower costs.” The Inspector General said that agency oversight of new health insurance marketplaces would focus on four primary areas of risk: payment accuracy, eligibility controls, contracting oversight, and privacy and security issues. He also said the agency would continue to focus on the use of health information technology, including the use of electronic health records.
At the end of January, the Office of Inspector General for the Department of Health and Human Services (“HHS-OIG”) released its 2014 Work Plan. The Work Plan summarizes new and ongoing reviews and activities that HHS-OIG plans to pursue with respect to HHS programs and operations in the coming year.
Gary Cantrell, Deputy IG for Investigations, outlined the issues facing his investigators for 2014. Chief areas of concern are prescription drugs and home based services. With prescription drugs, Cantrell said that in addition to pain medication abuse, which the agency has been combatting over the past few years, investigators have been finding cases of “pure financial greed” involving drugs that are not necessary or sometimes not even dispensed. In home health and personal care, services are often not being provided, or services are delivered but are not necessary. The patient harm that often accompanies financial fraud remains a strong focus of administrative efforts. Cantrell said that investigators would also be monitoring the transitions in health insurance, with an emphasis on identity theft and educating consumers so they are not victims of fraud schemes.
An appendix to the Work Plan identifies work-in-progress and planned reviews for 2014 related to the Affordable Care Act. For 2014, ACA oversight focuses on operation of the new health insurance marketplaces and the expanding Medicaid program. Increasingly, HHS-OIG resources are likely to be spent over this year and the coming years on oversight and investigation of the healthcare and insurance industry response to ACA.