August 28, 2017

OIG Reports That CMS Has Inadequate System for Identifying SNF Abuse

Holland & Knight Healthcare Blog
Shannon Britton Hartsfield

The U.S. Department of Health & Human Services Office of Inspector General (OIG) has issued an “Early Alert” regarding the preliminary results of an ongoing study of potential abuse or neglect in Medicare-certified skilled nursing facilities (SNFs). The OIG published a memorandum indicating that it identified 134 Medicare beneficiaries with injuries that may have resulted from abuse or neglect occurring from Jan. 1, 2015 to Dec. 31, 2016. A significant percentage of these incidents may not have been reported to law enforcement.

The complete report, dated Aug. 24, 2017, states that the OIG determined “that CMS procedures are not adequate to ensure that incidents of potential abuse or neglect of Medicare beneficiaries residing in SNFs are identified and reported.” CMS does not match Medicare claims for emergency room services with claims submitted by SNFs to identify instances of potential neglect or abuse.

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