Medicare Compliance & Reimbursement

Enforcement Watch:

Why 2005 Could See An Even Stronger OIG

Find out how the watchdog will be keeping busy with beefed-up funding.

The Medicare Modernization Act has a slew of new tasks for the HHS Office of Inspector General to juggle - but where is the funding it needs to keep pace? According to Senate Finance Committee leaders, the money had better be on its way.

In the Sept. 14 letter to Senate appropriators, Sen. Chuck Grassley (R-IA) and Sen. Max Baucus (D-MT) try to reverse a technical snag in the drafting of the MMA that prevents the Centers for Medicare & Medicaid Services from giving the OIG any of the $1 billion earmarked for the bill's implementation. 

"Congress routinely relies on the OIG's important oversight work and it's of paramount importance that we provide the OIG with resources commensurate to the task it faces," the letter reads. "We would urge the Appropriations Committee to redirect $25 million of the $1 billion ... to the OIG." 

The Senators also laid out a host of new reform bill hot spots the watchdog agency will need to target. Here's a glimpse of what could be on top of the to-do list:

  • audits of drugmakers and surveys of Medicare Part B drugs' market prices; 

  • statutory requirements relating to safe harbors for electronic drug prescriptions;

  • effects of Medicare payment rates on hematology and oncology drugs; 

  • prices of drugs included in the end-stage renal disease composite rate; 

  • payment methods for training residents in non-hospital settings; and 

  • notices to beneficiaries relating to hospital lifetime reserve days.

    Lesson Learned: the OIG could be strengthened by a hefty budget update in 2005.
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