The OIG’s December 2012 Compendium of Unimplemented Recommendations highlights unimplemented OIG recommendations that the OIG believes represent significant opportunities for action in FY 2013. The report includes recommendations made through FY 2011 that were not fully implemented as of December 2012. The OIG’s priority open recommendations, which in the OIG’s view represent the most significant opportunities to positively impact HHS’s programs, include the following:
- Medicare Parts A and B: Eliminate or reduce Medicare payments for hospital bad debts; adjust global surgery fees to reflect the number of evaluation and management services actually being provided by physicians; reduce the rental period for Medicare home oxygen equipment; ensure that hospice claims for beneficiaries in nursing homes comply with Medicare coverage requirements; implement unannounced site visits and other actions to prevent improper payments to independent diagnostic testing facilities; and ensure that claims for lower limb prostheses meet requirements.
- Medicare Part C/Medicare Advantage (MA): Modify payments to MA organizations; and MA aggressive marketing/ensure that new enrollees understand plan rules.
- Medicare Part D Prescription Drug Benefit: Develop a comprehensive safeguard strategy for overseeing Part D prescription drug plans; ensure the accuracy of sponsors’ cost estimates in Part D bids; ensure the validity of prescriber identifiers on claims; and ensure that Part D sponsors have information needed to make accurate coverage and reimbursement determinations for atypical antipsychotic drugs.
- Medicaid Reviews: Develop national pharmacy acquisition cost data as a benchmark for reimbursing prescription drugs; establish a connection between the calculations of Medicaid drug reimbursements and rebates; extend the additional rebate payment provisions for brand-name drugs to generic drugs; limit Medicaid payments to costs and require that payments returned by public providers be used to offset the federal share; and improve Medicaid children’s utilization of preventive screening services.
- Public Health Reviews: Centers for Disease Control and Prevention/improve states’ and localities’ medical surge preparedness for pandemics; FDA/ensure that clinical investigators disclose all financial interests; FDA/improve and strengthen food facilities’ compliance with records requirements for traceability of food products; Indian Health Service/reduce overpayments for contract health services hospital claims and cap payments for nonhospital services at Medicare rates; and National Institutes of Health (NIH)/Require NIH grantee institutions to identify, report, and address institutional financial conflicts of interest.