Office Of The Inspector General

Feds looking to QAPI, not penalties, for help

Feds looking to QAPI, not penalties, for help

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Centers for Medicare & Medicaid Services officials said they consider the upcoming Quality Assurance and Performance Improvement guidelines, not harsher penalties, as the better way to reduce adverse events in post-acute care.

Feds recover $10 million in incorrect Medicaid payouts

Feds recover $10 million in incorrect Medicaid payouts

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Federal investigators recovered more than $10 million in incorrect Medicaid payments made to nursing homes in 2013, an annual review shows.

OIG focuses on nursing homes' quality of care in 'priorities' report

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To best protect federal health programs, more action should be taken to improve nursing home quality, a new government report asserts.

Referral fees OK, says OIG

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A long-term care provider that requested clearance for a system of paying an agency to refer patients is in the clear.

OIG plans to scrutinize skilled nursing facilities' Medicare Part A claims

OIG plans to scrutinize skilled nursing facilities' Medicare Part A claims

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Skilled nursing operators can expect to see a new government report on Medicare Part A billing practices released in 2014, according to the latest annual work plan from the Department of Health and Human Services Office of the Inspector General.

OIG: Hospices often out of compliance, need framing

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The Department of Health and Human Services' watchdog arm recently said hospice providers need stronger oversight measures. It also noted more than $5.8 billion in recoveries in fiscal 2013.

Overdocumentation and cloning in electronic health records are overlooked risks, investigators say

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Auditors reviewing Medicare and Medicaid claims from electronic health records are largely treating them in the same manner as paper claims, even though they pose unique risks for overbilling and fraud, according to a government report released Wednesday.

Progress in the hospital 'observation stay' chaos

Progress in the hospital 'observation stay' chaos

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When you complain about bizarre government conditions or regulations, as columnists are wont to do, you usually have to assume you're just whispering into a stiff wind. But now comes word that no less than the Office of Inspector General of your Department of Health and Human Services is jumping on the bandwagon to change the hospital "observation stay" madness.

OIG: Hospitals err 18% of the time with point-of-admission indicators

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A lack of uniformity among hospital coders for developing conditions is a main reason for the "point of admission" errors, according to a Monday report from the Department of Health and Human Services Office of Inspector General.

OIG should streamline Medicare's self-disclosed overpayment protocol, provider group says

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Federal officials need to provide clearer guidance and offer a more streamlined protocol for providers willing to self-disclose Medicare overpayments, a leading long-term care group says.

Many nursing homes are not meeting federal standards for antipsychotic use, OIG review finds

Many nursing homes are not meeting federal standards for antipsychotic use, OIG review finds

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Many nursing facilities are not compliant with federal regulations governing residents who take atypical antipsychotic medications, a federal review released Monday reveals.

OIG: Volunteer Medicare fraud patrols had declining recovery in 2011

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The success rate of Medicare's volunteer force of fraud-detecting beneficiaries is declining, a government report finds.

Letter: Provider group accuses CMS of using Medicare audits for 'stealth policymaking' purposes

Letter: Provider group accuses CMS of using Medicare audits for 'stealth policymaking' purposes

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A provider group is taking the Centers for Medicare & Medicaid Services to task for improperly using Medicare audits as a means of curtailing high-intensity therapy in skilled nursing facilities.

Most meds used by dual eligibles are covered by Medicare Part D, OIG says

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The vast majority of the medications used by people who are dually eligible for Medicare and Medicaid can find what they need through Medicare Part D formularies, a federal report finds.

Lawmakers blast federal efforts to monitor and police Medicare fraud -- again

Lawmakers blast federal efforts to monitor and police Medicare fraud -- again

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Lawmakers again hammered the Centers for Medicare & Medicaid Services' Medicare program integrity contractors Friday. The latest salvos were fueled by an agency admission that additional mistakes had been made.

OIG: Regulators need to sharpen retrieval of Medicare overpayments made to providers

OIG: Regulators need to sharpen retrieval of Medicare overpayments made to providers

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Medicare recovery audit contractors have not been diligent enough in collecting previously identified overpayments, a government investigation finds.

More collaboration between Medicare and Medicaid fraud detection programs is needed, report finds

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More communication is needed between Medicare and Medicaid's respective program integrity officials, a new report suggests.

Lack of documentation accounts for Medicare fee-for-service error rate

Medicare's fee-for-service error rate for fiscal 2010 would have fallen if compliance contractors had successfully obtained better claims documentation, a federal report found.

Survey: Most nursing home administrators say background checks are helpful, efficient

Survey: Most nursing home administrators say background checks are helpful, efficient

Criminal background checks have not been found to significantly limit the quantity or quality of candidates for nursing home jobs, a top nursing home advocate says. A recent government survey of nursing home administrators paints an accurate picture of what once was forecast as a contentious issues, LeadingAge Director of Advocacy Information Barbara Gay told McKnight's Wednesday.

Nursing homes should be penalized for overuse of antipsychotic medications for dementia residents, federal investigator says

The Centers for Medicare & Medicaid Services should penalize physicians and nursing homes that continue to inappropriately prescribe and administer antipsychotic medications to dementia residents, regulators urged Wednesday.

OIG: Nursing home agreement with supplier would violate anti-kickback statutes

Agreements that would let a medical supply company become an exclusive supplier to a county-run skilled nursing facility would likely violate anti-kickback statues, the Office of the Inspector General said in an advisory opinion posted Thursday.

Inspector general recommends lower Medicare payment rates to nursing home hospices

Inspector general recommends lower Medicare payment rates to nursing home hospices

A new federal audit has found that Medicare spending on nursing home hospice patients increased by 69% over four years. Now, regulators are recommending a reduction in payment levels for nursing home-based hospice patients.

OIG: Higher than average nursing home payments might indicate fraud

OIG: Higher than average nursing home payments might indicate fraud

Nursing homes that collect daily Medicare Part B payments that are more than three times the national average should be closely monitored for possible fraud and abuse, according to a new Office of the Inspector General report that was issued Friday.

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