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8/15/2000

Audit Plans Outlined

Cheryl A. Thompson

Medicare and Medicaid audits, evaluations, and enforcement activities planned by the Health and Human Services Department’s Office of Inspector General were recently outlined.

During testimony March 28 before a subcommittee of the House Appropriations Committee, Inspector General June Gibbs Brown described Medicare- and Medicaid-related projects expected to be completed by the end of fiscal year 2001.

Medicare-related projects include the following topics:

  • Pneumonia upcoding by hospitals, 
  • Critical care services in hospitals, 
  • End-stage renal disease services, 
  • Compliance program monitoring, 
  • Impact of the Balanced Budget Act reforms on home health, 
  • Impact of the implementation of the prospective pricing system on skilled-nursing facilities, and 
  • Improper hospital discharges and transfers.

Medicaid-related projects include the following topics:

  • Outpatient prescription drugs, 
  • Potentially excessive claims, 
  • Payments to disproportionate share hospitals, and 
  • Payments for pharmacy claims from liable third parties.