OIG Report Affects Nursing Facilities

MacKenzie Kimball, March 29, 2010

The Department of Health and Human Services' (HHS) Office of Inspector General (OIG) recently released its Compendium of Unimplemented Office of Inspector General Recommendations, which highlights a variety of OIG recommendations that had not been fully implemented as of September 30, 2009.

A handful of the unimplemented recommendations included in the report are related to nursing homes:

  • Ensure that states properly maintain nurse aide registries

  • Update nurse aide training curriculum

  • Ensure that hospice claims for beneficiaries in nursing facilities comply with Medicare coverage requirements

  • Ensure that Part B payments are appropriate for beneficiaries' medical equipment during non-Part A nursing facility stays

  • Ensure that Medicare Part D excludes payments for drugs for beneficiaries in Part A skilled nursing facility stays

"Clearly, if implemented, the recommendations could have an effect on nursing facilities," says Wayne van Halem, AHFI, CFE, president of the van Halem Group, LLC, in Atlanta, GA. "Reviewing the information is an excellent source for facilities to determine focus of their own internal controls.

"For example, the document talks about training for nursing aides. Clearly, OIG found the training to be insufficient, as a provider should certainly have an effective training program in place for all employees as part of their regular compliance and control process. So, they may want to review their training programs for nursing aides."

The OIG report also includes a list of priority recommendations, which in the OIG's opinion "represent the most significant opportunities to positively impact HHS' programs." One of these priority recommendations was to ensure the appropriate processing of denial of Medicare payment remedies for noncompliant nursing homes.

"Some of these recommendations will never be implemented because CMS has come up with different solutions or it requires a change in legislation; however, some may very well be implemented," van Halem says. "More than anything else, this OIG report is a good resource for facilities."

MacKenzie Kimball MacKenzie Kimball is an associate editor in the long-term care market at HCPro. She writes PPS Alert for Long-term Care and manages MDSCentral.
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