OIG Work Plan 2000: Pharmaceuticals, Home Care, and Hospice—What are the Risks?

Abstract

As we move forward in the new century, the Office of Inspector General (OIG) continues to release additional compliance model guidelines and to investigate new health care service components. The focus is on not only on home care, hospice, and durable medical equipment, but has expanded this year to prescription medications and whether Medicare payments for prescription medications through managed care insurers should be initiated. The president announced that purchasing needed prescriptions was a major burden to the elderly and proposed to fund this benefit in the future. Although at first glance it is well recognized that this need does exist within the community, it is important to realize that along with Medicare reimbursement comes many questions to be answered. The proposal included an annual deductible and cost for coverage, and if such coverage comes into reality the current OIG surveillance of pharmacies will only increase and providers of any medication will experience increased scrutiny. But how does today’s OIG 2000 Work Plan focus on pharmacies impact home health and hospice organizations? These organizations potentially stand to experience significant impact from the spin-off from these investigations. Some of the risks identified for prescription programs and pharmacies include drug expiration dates exceeded, improper billing of medications, medication sharing by beneficiary and others, and staff abuse of medications present. HOME HEALTH IMPLICATIONS