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HHS inspector general announces 2013 work plan

October 08, 2012

By Craig Palmer, ADA News staff

Washington—Federal health investigators say they will review Medicare and Medicaid dental payments as part of their 2013 work plan.

The 148-page work plan (PDF) for the Department of Health and Human Services Office of Inspector General is primarily “directed toward safeguarding the integrity of the Medicare and Medicaid programs and the health and welfare of their beneficiaries” but extends to oversight of all HHS programs.

Hospitals—Outpatient Dental Claims

“We will review Medicare hospital outpatient payments for dental services to determine whether such payments were made in accordance with Medicare requirements,” the work plan says. “Dental services are generally excluded from Medicare coverage, with a few exceptions. For example, Medicare reimbursement is allowed for the extraction of teeth to prepare the jaw for radiation treatment. As indicated by current OIG audits, providers received Medicare reimbursement for noncovered dental services, which resulted in significant overpayments.” This is described as a fiscal year 2013 “new start.”

Dental Services for Children—Inappropriate Billing (New)

“We will review Medicaid payments by states for dental services to determine whether states have properly claimed federal reimbursement. Dental services are required for most Medicaid-eligible individuals under age 21 as a component of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services benefit. Federal regulations define 'dental services’ as diagnostic, preventive or corrective procedures provided by or under the supervision of a dentist. Services include the treatment of teeth and the associated structure of the oral cavity and disease, injury or impairment that may affect the oral cavity or general health of the recipient. Prior work indicates that some dental providers may be inappropriately billing for services.” This is described as a “work in progress.” The word “New” after the title means the project did not appear in the previous year work plan.

Dental Services for Children—Billing Patterns in Five States (New)

“We will review billing patterns of pediatric dentists and their associated clinics in five selected states. Medicaid covers comprehensive dental care for approximately 30 million low-income children through the EPSDT benefit. Under EPSDT, states must cover dental services and dental screening services for children. OIG investigations have identified numerous vulnerabilities with pediatric dental care, particularly with the care provided by certain for-profit dental chains.” This is also a “work in progress.”

The Office of Inspector General will also investigate HHS regulation of the Medicare provider and supplier enrollment and reenrollment process; the extent to which Medicare Provider Enrollment, Chain, and Ownership (PECOS) data are complete, consistent and accurate; Medicare payment for Part B imaging services; security controls implemented by Medicare and Medicaid contractors and hospitals to prevent loss of protected health information stored on portable devices and media; beneficiary access to Medicaid managed care, and the performance of state Medicaid fraud control units.

PECOS is the system the Centers for Medicare & Medicaid Services uses to complete enrollments online.

Other work plans include:

  • review of the policies and activities of the patient safety organizations certified to collect and analyze reports of adverse events from hospitals and other health care settings;
  • monitoring of health care professionals’ fulfillment of National Health Service Corps obligations;
  • HHS implementation of key areas in its pandemic influenza plan;
  • fraud vulnerabilities presented by electronic health records, and
  • review of new programs and initiatives created by the Affordable Care Act and expansion or modification of existing HHS programs and operations as they relate directly or indirectly to the ACA.