OIG’s November Plan on Opioid Prescribing and Telemedicine

Following the previous two work plan publications this year, OIG has come up with another strategy where it will be updating its work plan on a monthly basis. In November, the four plans are;

  • OIG will be evaluating the prescriptions for opioids to Medicaid. Their observation was that Medicaid beneficiaries mostly the disabled are more vulnerable to abuse of opioids since they tend to suffer from conditions that require pain relief. OIG will be examining the issue by considering both the prescriber and the beneficiary side. The prescriber may include doctor or pharmacy. The study aims to come up with a baseline of beneficiaries receiving extreme amounts of opioids and identify the prescribers who are giving excessive or too much of opioids to recipients.
  • OIG wants to study if Medical payments made for services provided through telecommunication systems fulfilled the requirements of Medicaid. The OIG will determine if all the telehealth services that may be delivered through audios and videos and any services that beneficiaries get through interactive transmissions are all paid for in the required manner.
  • The Medicaid Managed Care Organizations (MCOs) will be examined by the OIG to check if it is using Medicaid funds to offer proper care to the Medicaid MCO enrollees. These are funds that MCOs receive inform of capitation payments which come from over 40 percent of federal Medicaid expenditures. The OIG aims to ensure that the capitation rates are set appropriately so that they can provide adequate services to the beneficiaries.
  • OIG will be determining the way hospitals are billing for severe malnutrition. The condition is common among the elderly especially those who are seriously ill. Malnutrition can be as a result of inadequate treatment, treatment of a different disease, negligence or general worsening of the patient’s health. Hospitals are expected to bill for the treatment of this condition based on how serious the state is, which can be mild, moderate and severe. Severe malnutrition is a significant complication and increases Medicare reimbursement. OIG will be reviewing the precision of the claims to Medicare for the treatment of acute malnutrition.