The OIG issues its 2010 Work Plan

The Office of Inspector General (“OIG”) has issued its Work Plan for fiscal year
(FY) 2010. (The effective date is October 8, 2009.) The OIG issues a Work Plan each year that describes activities that the agency plans to initiate or continue with respect federal health care programs. The full document can be located at the following link. http://oig.hhs.gov/publications/docs/workplan/2010/Work_Plan_FY_2010.pdf


However, A quick review of the Work Plan yielded the following observations.

● Sleep Studies-According to the Work Plan, Medicare payments for polysomnography increased from $62 million in 2001 to $215 million in 2005. So the OIG will examine the factors contributing to the rise in Medicare payments for sleep studies, as well as the appropriateness of Medicare payments for sleep studies.

● Epidural Injections-According to the Work Plan, Medicare Part B physician claims for transforaminal epidural injections increased by 130 percent between 2003 and 2007. So the OIG will review Medicare claims to determine the appropriateness of Medicare Part B transforaminal epidural injections as an interventional technique to diagnose or treat back problems.

● Use of the GY modifier-We have always been under the impression that many medical practices are unaware of the GY modifier, which is to be used for coding services that are statutorily excluded or do not meet the definition of a covered service. Apparently the code is more widely used than we believed. According to the OIG, in FY 2008, Medicare received over 75.1 million claims with a modifier GY totaling approximately $820 million. The OIG plans to examine patterns and trends for physicians’ and suppliers’ use of modifier GY.

● Independent Diagnostic Testing Facilities-Not surprisingly, IDTFs remain an area of concern for the OIG. A 2006 OIG review raised concerns with IDTFs, and suggested that Medicare had made improper payments of $71.5 million to IDTFs. With overutilization on everyone’s minds these days, it is not surprising that the OIG plans to review services and billing patterns in geographic areas with high concentrations of
independent diagnostic testing facilities (IDTF).

● X-Rays in Hospital Emergency Departments-Yet another recurring issue involves Medicare Part B claims for diagnostic x-rays performed in hospital emergency departments. According to the Work Plan, in 2007, Medicare reimbursed physicians approximately $207 million for imaging interpretations performed in emergency departments. The OIG plans to determine the appropriateness of payments for diagnostic x rays and interpretations.

As far as the OIG’s planned activities regarding Medicaid are concerned, drugs, drugs and more drugs. Among the issues the OIG plans to review are: Timely Submission of Average Manufacturer Price Data, Calculation of Average Manufacturer Prices, Recalculation of Base Date Average Manufacturer Prices, Rebates of Brand-Name Drugs, and several others.

However, the OIG also plans to review Medicaid payments for dental care. According to the OIG, in 2007, Medicaid costs for dental services totaled more than $3 billion. So it appears that the audits of dental practices providing care to Medicaid beneficiaries will continue.