The U.S. Department of Health and Human Services Office of Inspector General (OIG) has released its Work Plan for fiscal year (FY) 2010. In the Work Plan, the OIG describes activities the office plans to initiate or continue. The OIG protects program integrity and beneficiaries by detecting and preventing waste, fraud, and abuse through audits, evaluations, and investigations and providing guidance to industry. The studies will cover many areas including hospitals, nursing homes, prescription drugs, Medicaid and CHIPS. Some of the upcoming studies involve imaging services and durable medical equipment.

The plans for reviewing imaging services include:

--Reviewing Medicare Payments for Part B Imaging Services; the focus will be on practice expense components including the equipment utilization rate. The OIG will determine whether Medicare payment reflects actual expenses incurred and whether the utilization rate reflects current industry practices.

--Geographic Areas with a High Density of Independent Diagnostic Testing Facilities (IDTF); the OIG will review service, provider and beneficiary profiles and billing patterns in these areas. The OIG is taking up this study following a 2006 review that found numerous incidences of noncompliance with Medicare standards and possible improper payments.

--Enrollment Standards for IDTFs; the OIC will review those IDTFs enrolled in Medicare to determine if they meet Medicare enrollment standards including compliance with federal and state licensure and regulatory requirements for health and safety of patients and technical staff with appropriate credentials.

--Payments for Diagnostic X-Rays in Hospital Emergency Departments; the OIG will review samples of Medicare Part B paid claims and medical records for diagnostic X-Rays in ERs to determine payment appropriateness.

The plans for reviewing durable medical equipment services include:

--Physician Self-Referral for Durable Medical Equipment (DME) Services; the OIG will review Medicare payments for DME services to determine allowability of physician self-referrals to DME suppliers in which physicians held ownership interests.

--Medicare Payments for Various Categories of Durable Medical Equipment; the OIG will review the appropriateness of Medicare Part B payments to DME suppliers of power mobility devices, hospital beds and accessories, oxygen concentrators, and enteral/parenteral nutrition. The reviews will be in selected geographic areas with high-volume claims. This follows previous OIG reviews that have found payments for DME not ordered by physicians, not delivered to the beneficiaries, or not needed by beneficiaries.

--Medicare Enrollment and Monitoring for Suppliers of DME, Prosthetics, Orthotics, and Supplies and Home Health Agencies (HHA); the OIG will assess Medicare contractors' use of enrollment screening mechanisms and post-enrollment monitoring activities to identify DME and HHA applicants that might be fraud risks to Medicare, and the extent applicants omitted ownership information on the enrollment applications. A past OIG study found inaccurate or omitted information on DME and HHA enrollment applications.

The full OIG Work Plan for FY 2010 can be accessed at: http://www.oig.hhs.gov/publications/docs/workplan/2010/Work_Plan_FY_2010.pdf

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Imaging Costs Prompt OIG Inspections
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