HHS Publishes Semi-Annual Report to Congress

The US Department of Health and Human Services (HHS) Office of Inspector General (OIG) has issued its Semi-Annual Report to Congress covering the period of October 1, 2017 through March 31, 2018. These Reports describe OIG’s work to identify and investigate significant issues and deficiencies related to the administration of HHS programs and operations. We thought the following findings were of particular interest for XiFin clients and partners:

Improper Payments Made for Specimen Validity Tests Billed in Combination with Urine Drug Tests

One of the findings that we at XiFin found particularly interesting is related to improper payments to clinical laboratories and physician offices for specimen validity tests billed in combination with urine drug tests. According to the OIG report, the improper payments occurred because providers did not follow Medicare guidance, and the Centers for Medicare & Medicaid Services’ (CMS’s) system edits were not adequate to prevent payment for specimen validity tests billed in combination with urine drug tests.

According to the report, medically necessary tests used to diagnose certain conditions (which include the same tests that can be used to validate urine specimens) that are performed on the same day as a urine drug test for a single beneficiary should be a rare occurrence. CMS has directed Medicare contractors to recover the $66.3 million in identified improper payments and will further strengthen its system edits to prevent these improper payments in the future.

Update on the Quality Payment Program (QPP)

Another interesting section of the report focuses on the implementation of QPP, a set of clinician payment reforms designed to put increased focus on the quality and value of care. According to the report, CMS has made progress to address two vulnerabilities it has been focused on:

• Developing IT systems – according to the report, CMS appears on track to deploy the needed IT systems.
• Preparing clinicians – CMS has communicated eligibility information, issued guidance, awarded technical assistance contracts, and set up a service center to handle clinician questions. These actions were in direct response to clinician feedback, which included lack of certainty about eligibility and data submission requirements.

OIG found that CMS had not yet developed a comprehensive program integrity plan and identified two new vulnerabilities that they have asked CMS to address in 2018:

• Providing sufficient technical assistance to enable clinicians to succeed under the QPP, and therefore participate.
• Develop and implement a comprehensive QPP program integrity plan.

Medicare Shared Savings Program (MSSP) Integrity

Finally, we thought it worth noting that OIG reports CMS has ensured that MSSP beneficiaries have been properly assigned, meaning that beneficiaries were assigned to only one Accountable Care Organization (ACO) and were not assigned to any other shared savings programs. This is important so the quality of care for Medicare fee-for-service beneficiaries is improved while costs are reduced.