Tag: Office of Inspector General

OIG releases new report, prompting CMS to publish new fact sheet for 3-day rule

The HHS Office of Inspector General (OIG) has released the “Solutions to Reduce Fraud, Waste, and Abuse in HHS Programs: Top Unimplemented Recommendations” which includes eight recommendations to CMS regarding Medicare Parts A and B: CMS should analyze the potential impacts of counting time spent as an outpatient toward the 3-night requirement for skilled nursing […]

Congress reintroduces bill to count observation stays as three-day prerequisite for SNF coverage

Congress has reintroduced a bill that would ensure patients receiving hospital care under “observation status” could count that time as part of the three-day inpatient hospital stay required to receive skilled nursing care coverage under Medicare. The Improving Access to Medicare Coverage Act of 2017 (HR 1421) mirrors a similar bill introduced in 2015. In […]

OIG updates LEIE Database: Why should LTC providers be aware of this?

An updated List of Excluded Individuals and Entities (LEIE) Database file has been released by the Department of Health and Human Services, Office of Inspector General (OIG), including all OIG exclusions and reinstatements made through February 2017. Why do LTC providers need to know about this? The OIG recommends long-term care providers check this list […]

OIG finds Medicare’s “two-midnight stay” limits SNF care

The OIG has identified vulnerabilities in CMS’ “two-midnight” policy in a report published December 19, 2016. The two-midnight policy mandates that beneficiaries be admitted to the hospital for “two midnights” in order to be considered an inpatient admission and receive Medicare Part A coverage. In order for beneficiaries to be covered under Medicare for treatment […]

OIG’s FY17 work plan will investigate quality and Medicare billing accuracies in skilled nursing facilities

The Office of Inspector General’s (OIG) FY17 work plan has been released and its proposed sections align with the new/revised CMS Medicare guidelines. Some of the work plan’s sections promise to address areas of continual concern, such as unnecessary or fraudulent ultra-high therapy claims made by SNFs, while other areas of the plan will address […]

OIG releases 2014 work plan

The Office of Inspector General (OIG) released a report that focused on its fiscal year 2014 Work Plan. The work plan summarizes the activities the OIG plans to pursue with respect to HHS programs and operations during the current fiscal year (FY) and future years. The OIG Work Plan for FY 2014 provides brief descriptions […]