This week, the U.S. Department of Health and Human Services (“HHS”), Office of Inspector General (“OIG”) fulfilled its annual statutory obligation by releasing its 2024 Top Management and Performance Challenges Report (the “Report”). Historically, the Report has not attracted widespread interest in the provider community because it largely focuses on HHS operational challenges. Importantly for providers and other stakeholders, however, the Report reveals crucial insights about compliance priorities for the year ahead.
The Report identifies five key challenge areas: (1) public health; (2) financial integrity; (3) Medicare and Medicaid; (4) beneficiary safety; and (5) data and technology security.
The Report highlights recurring concerns in areas such as:
- hospice, home health, hospital outpatient, and skilled nursing facility care;
- genetic and clinical laboratory testing;
- durable medical equipment; and
- treatment for substance use disorders.
The Report also details emerging concerns such as:
- payment for skin substitutes;
- hospital inpatient upcoding;
- unnecessary surgical, imaging, and other procedural care; and
- sub-recipients’ use of grant funds for intended purposes.
Significantly, the Report recommends HHS strengthen its provider enrollment screening and revalidation processes and its use of data analytics. The Report also advocates for increased use of prepayment suspensions and suspension and debarment actions to protect against fraud, waste, and abuse and to hold individual wrongdoers accountable.
Accordingly, providers and other stakeholders operating in these “high-risk” areas must remain vigilant. With year-end fast approaching, now is the time to evaluate the effectiveness of your compliance program and make any necessary adjustments to start 2025 with confidence.
A complete copy of the 2024 TMC document is available here.
Should you have any questions regarding the above or would like an evaluation of your compliance program, please contact the authors, the Garfunkel Wild attorney with whom you regularly work, or email us at [email protected].