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OIG Report Could Trigger Increased CMS Oversight of Skilled Nursing Facilities

The U.S. Department of Health & Human Services ("HHS") Office of Inspector General ("OIG") recently issued a preliminary report regarding quality of care concerns at skilled nursing facilities ("SNFs"). The report was issued in connection with the OIG's ongoing review of potential abuse and neglect of Medicare beneficiaries in SNFs.

The OIG noted in its report that it identified 134 Medicare beneficiaries residing in 33 different states who suffered injuries that may have been the result of potential abuse or neglect from January 1, 2015 through December 31, 2016.The OIG found that 28 percent of these incidents may not have been reported to law enforcement. Therefore, the OIG determined that the Centers for Medicare & Medicaid Services ("CMS") has inadequate procedures in place to ensure that incidents of potential abuse or neglect of Medicare beneficiaries residing in SNFs are identified and reported.

The OIG suggested in its report that CMS take immediate action to (1) implement procedures to compare Medicare claims for emergency room treatment with claims for SNF services to identify incidents of potential abuse or neglect of Medicare beneficiaries residing in SNFs and periodically provide the details of this analysis to the CMS Survey Agencies for further review; and (2) continue to work with the HHS Office of the Secretary to receive the delegation of authority to impose the civil monetary penalties and exclusion provisions of Section 1150B of the Social Security Act.

Section 1150B requires employees of federally funded long-term care facilities to immediately report any reasonable suspicion of a crime committed against a resident of that facility. Those reports must be submitted to at least one law enforcement agency and the applicable CMS Survey Agency. Covered individuals who fail to report under section 1150B are subject to various penalties, including civil monetary penalties of up to $300,000 and possible exclusion from participation in any Federal health care program.

Medicare regulations require SNFs to establish and implement written policies to ensure the reporting of crimes that occur in federally funded SNFs in accordance with Section 1150B.

As a result of the OIG report, SNFs should be prepared for increased CMS enforcement activity, especially with regard to the reporting of potential abuse or neglect of SNF residents. SNFs should ensure that they have written policies in place regarding the reporting of such incidents, and that those policies have been communicated to staff members.

Please contact a member of Foster Swift's health care practice group with any questions.

Categories: Long Term Care, Medicare/Medicaid

 has particular expertise in health law and she represents providers with emphasis in the areas of physicians, hospice, home care and long term care, including one of the country’s largest long-term care organizations. She has a vast array of experience in teaming with providers in the areas of regulatory compliance and contracts. 

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