Tag: OIG

OIG: Medicare overpaid HHAs nationally $191.8 million in audit period

A recent OIG report suggests that the MACs could be recouping money they believe was incorrectly paid for home health episodes that ended with five to seven visits, slightly above the LUPA thresholds in PPS. And they could be enforcing stricter oversight of periods just above new LUPA thresholds in PDGM. Twenty out of 25 […]

OIG investigates COVID-19 response at nursing homes

The OIG announced a focused effort to investigate nursing home responses to COVID-19. One facet of the investigation will focus on auditing infection control efforts at nursing homes, while another will focus on CMS oversight efforts during the pandemic. “To reduce the likelihood of contracting and spreading COVID-19 at these nursing homes, effective internal controls […]

OIG releases updates on corporate integrity agreements

The Office of the Inspector General (OIG) released updated information related to Corporate Integrity Agreement (CIA) deadlines, OIG review deadlines and OIG enforcement activity. The OIG is working closely with CMS, Health & Human Services (HHS) and law enforcement partners to support health professionals’ response to the pandemic. They are taking burdens on providers and […]

OIG releases nursing home complaint trends

The Office of Inspector General (OIG) has released an interactive map detailing nursing home complaint trends between 2016 and 2018. The map breaks down the amount of complaints per 1000 residents in each state. Of the 50 states, and Washington D.C, nine states had more than 60 serious complains per thousand residents. The report found […]

OIG report suggests CERT data could identify ‘high-risk’ home health agencies

A report from the Department of Health & Human Services (HHS) Office of Inspector General (OIG) recommends using Comprehensive Error Rate Testing Data (CERT) to identify “high-risk” home health agencies to help reduce improper payments and agency error rates. CMS didn’t agree with the recommendation, however. Instead CMS points to CMS’ fraud prevention system, targeted […]

Background checks for long-term workers needs more attention from states

Several states are running behind on implementation of a national background check program covering home health agencies and hospice providers, among others. Only two out of 11 states that concluded their participation in the program in 2017 and 2018 implemented all the requirements, according to a report from the Office of Inspector General (OIG). The report contends the […]

OIG recommends changes for home health, hospice, personal care services to reduce fraud

In a July report, the Department of Health and Human Services Office of Inspector General (OIG) revisited its top 25 unimplemented recommendations for reducing fraud, waste and abuse. Several of the recommendations involve home health, hospice or personal care services. The OIG recommends the implementation of a statutory mandate requiring surety bonds for home health […]

OIG reports address deficiencies, abuse in hospice care

Two reports were released last week by the U.S. Department of Health and Human Services Office of the Inspector General (OIG) demonstrating the results of in-depth studies of Medicare hospice recertification and complaint survey data from state agencies and accredited organizations between 2012 and 2016. The reports examine issues of deficiencies and abuse in hospice care. […]

OIG report looks at abuse and neglect of Medicare beneficiaries

The Department of Health and Human Services Office of Inspector General issued two new reports that address the identification, reporting and investigation of incidents of potential abuse and neglect of our nation’s most vulnerable populations, including seniors and individuals with developmental disabilities. OIG issued an early alert in 2017 based on the preliminary findings of […]