Tag: OIG

Medicaid Fraud Control Units recover over $10 million in 2013

Medicaid Fraud Control Units recovered about $10.3 million from nursing facilities in FY 2013, according to an annual report issued Friday. Practically every state operates a fraud control unit, and the report from the Department of Health and Human Services Office of the Inspector General compiled results from all of these units. The investigations included: Allegations of […]

Severe cuts to SNF reimbursements proposed for FY 2015

In the budget document released by the Office of Management and Budget, the White House’s proposed 2015 budget includes severe cuts to skilled nursing facility reimbursements. This proposal is drawing strong criticism from the nation’s largest long-term care provider group. To cut federal spending on healthcare by $402 billion over the next 10 years, the […]

Adverse events occur during SNF stays

A recent study published by the Office of the Inspector General (OIG) found that over 20% of Medicare beneficiaries experience adverse events during their SNF stay. The study also found that an additional 11% experience temporary harm events during their SNF stay. The study estimated the national incidence rate, preventability, and cost of adverse events […]

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 […]

OIG releases new report on contractor error rate

The Office of the Inspector General (OIG) released a report that focused on the Centers for Medicare & Medicaid Services’ (CMS) Comprehensive Error Rate Testing (CERT) program. Read on to learn more about what the report found.

OIG report finds EHRs are being improperly reviewed by CMS

The Office of the Inspector General (OIG) recently released a report titled, “CMS and Its Contractors Have Adopted Few Program Integrity Practices to Address Vulnerability in EHRs” that finds that few CMS contractors from the Centers for Medicare & Medicaid Services (CMS) were reviewing electronic health records properly. According to the OIG report, electronic health […]

OIG releases 2014-2018 strategic plan and top management issues

The Office of the Inspector General (OIG) has released their strategic plan for 2014-2018. Their goals include: Fight fraud, waste, and abuse Promote quality, safety, and value Secure the future Advance excellence and innovation To read the full report, click here. The OIG also released their annual summary of the most significant management and performance […]

OIG study recommends developing new quality measure

A new Office of the Inspector General (OIG) study has recommended to the Centers of Medicare & Medicaid Services (CMS) that they develop a quality measure that describes nursing home resident hospitalization rates. The OIG study states: Nursing homes hospitalize residents when physicians and nursing staff determine that residents require acute-level care. Such transfers to […]

OIG releases report on Medicare A and B redeterminations

Earlier this month, the Office of the Inspector General (OIG) released a report titled, “The First Level of the Medicare Appeals Process, 2008-2012: Volume, Outcomes, and Timeliness”. According to the OIG, the Medicare appeals process serves as an important protection for beneficiaries and providers. Their study represents the first examination of redetermination, i.e., the first […]

OIG releases new report on RAC program and improper payments

On September 3, the Office of Inspector General (OIG) released a report titled, “Medicare Recovery Audit Contractors and CMS’s Actions To Address Improper Payments, Referrals of Potential Fraud, and Performance.” The report found that in 2010 and 2011, Recovery Audit Contractors (RAC) identified half of all claims they reviewed as having resulted in improper payments […]