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Two New OIG Reports Related to Nursing Homes

Lilly Hummel 

The Department of Health and Human Services Office of Inspector General (OIG) released a new data brief, finding that while states conducted nearly all the required onsite investigations for the most serious nursing home complaints within the required timeframes, a few states did not. The priority level that the State assigns to each nursing home complaint determines the State’s required action and timeframe for addressing the complaint. OIG found that each year, half of all nursing home complaints required prompt onsite investigation. Among the most serious complaints, the most common allegations related to quality of care or treatment. OIG stated that the brief offers CMS some insights into the specific states that have room to improve in prioritizing and responding to nursing home complaints. There were no recommendations, though the OIG did state that it will continue to monitor the oversight of nursing homes and will initiate additional reviews as necessary.

OIG has also released a new report finding that enhancements are needed in the tracking and collection of Medicare overpayments identified by zone program integrity contractors (ZPICs) and program safeguard contractors (PSCs). This study updates ongoing work reviewing the collection of ZPIC- and PSC-referred overpayments and identifies ongoing challenges that contractors face in tracking and collecting overpayments. Based on its study of collections in fiscal year 2014, OIG had several recommendations, including that the Centers for Medicare and Medicaid Services (CMS) identify and implement strategies to increase the identification of overpayments, as well as Medicare administrative contractors (MACs) collection of referred overpayments. To increase collections, OIG recommended that CMS should implement the surety bond requirement for home health providers and consider surety bonds for other providers based on their level of risk. CMS did not agree with this recommendation, and stated that it is evaluating how to effectively implement the surety bond requirement while avoiding undue provider burden.

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