Kusserow on Compliance: OIG Strategic plan outlines top priorities for 2020 – 2025

 The HHS Office of Inspector General (OIG) has identified seven major initiatives as part of its strategic plan for the period between 2020 and 2025. The initiatives include: (1) fraud and abuse protections; (2) safeguarding the Medicare trust funds; (3) protecting beneficiaries from prescription drug abuse; (4) combating health care cybersecurity threats; (5) promoting patient safety and accuracy of payments in home and community settings; (6) leveraging technology; and (7) ensuring HHS managed care and new health care models produce value.

  1. Fraud and Abuse Protections. OIG audits of national Medicaid data found substantial improper payments to providers for Medicaid Services; states were not always correctly determining lack of eligibility of individuals for Medicaid benefits. These two areas will be a focus for OIG oversight.
  2. Safeguarding the Medicare Trust Funds. The OIG plans to use data analytics to identify program areas and geographic areas of high-risk. It should provide strategic oversight of emergency preparedness and response affecting Medicare beneficiaries, Medicare Advantage, prescription drug spending, and the transition to value-based care.
  3. Protecting Beneficiaries from Prescription Drug Abuse, Including Opioids. The OIG’s efforts will focus on identifying opportunities to improve the efficiency and effectiveness of monitoring and identifying and holding accountable those engaged in fraud and abuse related to prescription drugs. Major efforts will include empowering partners through data sharing and education.
  1. Combatting Health Care Cybersecurity Threats. The OIG will increase efforts to combat cybersecurity threats, including hacking attacks, manipulation of medical devices, and inappropriate access to U.S. genomic data. The OIG will perform more cybersecurity audits of HHS agencies and programs, in partnership with other agencies, to conduct investigations that may involve espionage or foreign threats.
  1. Promoting Patient Safety and Accuracy of Payments in Home and Community Settings. The OIG plans increased efforts to reduce improper payments for services in noninstitutional settings, including home health. The OIG’s plans include outreach, education, audits, evaluations, inspections, investigations, and administrative enforcement.
  1. Leveraging Technology as it Intersects with HHS Programs. The OIG highlights that technology can be used to increase the efficiency, quality, and accessibility of the health care system. The OIG will work with other HHS agencies, patients, and providers to educate and oversee the use of health technology to positively impact providers and patients. The OIG will also assess how it can use Artificial Intelligence to foster value and quality in HHS programs.
  1. Ensuring HHS Managed Care and New Healthcare Models Produce Value. As CMS programs shift to value-based care and payment, the OIG has identified three elements that are critical to achieving better value, quality, and outcomes: (1) aligning program incentives with improved health outcomes; (2) strengthening program integrity; and (3) delivering innovative technology. The OIG will oversee the continued transition to value-based programs and will address and combat any issues of fraud, waste, and abuse.


Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

Connect with Richard Kusserow on LinkedIn.

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Copyright © 2020 Strategic Management Services, LLC. Published with permission.