Tag: OIG

OIG warns providers about COVID-19 vaccine fraud and abuse

The Department of Health and Human Services Office of Inspector General is reminding providers of the rules around administering the COVID-19 vaccine after complaints from patients charged for the vaccine and other reports of fraud and abuse around vaccine distribution. OIG is reminding all participating providers that they: must administer COVID-19 Vaccine with no out-of-pocket […]

Latest OIG audit suggests case-mix reductions a red flag for claim reviews

The U.S. Department of Health and Human Services Office of Inspector General (OIG) recently announced the results of an audit of Brookdale Home Health. The report came a familiar focus on ambulation, homebound and medical necessity. But there was another important note in the report that puts a fresh emphasis on case mix. The review […]

OIG releases message on telehealth reviews

The U.S. Department of Health and Human Services Principal Deputy Inspector General Christi A. Grimm recently released a message regarding telehealth. “Where telehealth and other remote access technologies were once a matter of convenience, the public health emergency made them a matter of safety for many beneficiaries,” says Grimm. A year later, there is strong […]

OIG announces investigation into nursing home discharges and evictions

The OIG announced plans to investigate whether nursing homes are following proper protocol when discharging and evicting residents. The OIG found that discharges and evictions were the most common compliant submitted to the Long-Term Care Ombudsman Program from 2011 to 2016. “Discharges which violate federal regulations are of great concern because in some cases they […]

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 […]