Tuesday, March 20, 2018

Updated OIG Work Plan

The Department of Health and Human Services Office of Inspector General (OIG) has recently added to its work plan, which it began updating monthly in 2017. 

Several new work items are relevant to long-term care providers, including:

  • State Medicaid Fraud Control Units (MFCU) FY 2017 Annual Report: This annual report will analyze the statistical information that was reported by the MFCUs for FY 2017, describing aggregate outcomes of MFCU criminal and civil cases. This report will also identify trends in MFCU case results and will report on significant developments for the MFCUs over the course of the year.
  • Potential Abuse and Neglect of Medicare Beneficiaries: The Elder Justice Act recognizes an older person's rights, including the right to be free of abuse, neglect, and exploitation. In addition, all 50 States have mandated reporter laws for the reporting of the potential abuse or neglect of elders and vulnerable persons. Prior OIG reviews have shown that there are problems with the quality of care and the reporting and investigation of potential abuse or neglect at group homes, nursing homes, and skilled nursing facilities. By analyzing the treating medical facilities' diagnoses, OIG seeks to determine the prevalence of the potential abuse or neglect of Medicare beneficiaries. It will also determine whether the potential abuse or neglect occurred at a medical facility or at another location, such as the Medicare beneficiary's home.
  • Status Update on States' Efforts on Medicaid-Provider Enrollment: Previous OIG work found that many States had yet to complete fingerprint-based criminal background checks and site visits. The Centers for Medicare and Medicaid Services (CMS) continues to extend the deadline for completion of fingerprint-based criminal background checks, indicating that states are still working on provider enrollment. For this Status Update, OIG will determine the extent to which states have completed fingerprint-based criminal background checks and site visits, and challenges to implementation.
  • State Compliance With Requirements for Reporting and Monitoring Critical Incidents: OIG has conducted prior research finding that some states did not always comply with federal and state requirements for reporting and monitoring critical incidents such as abuse and neglect. OIG will review additional state Medicaid agencies to determine whether the selected states are in compliance with the requirements for reporting and monitoring critical incidents. OIG reports that its work will focus on Medicaid beneficiaries residing in both community-based settings and nursing facilities.

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