Upcoming OIG Reports Signal Coming Regulatory Priorities

The Office of the Inspector General (OIG) at Health and Human Services (HHS) added a significant number of reports to its active Work Plan in 2020. While some, as expected, relate to Infection Control and COVID-19, the bulk of the reports look at long-standing concerns of regulators – and are areas that providers should be focusing on as well. Pressure from the findings of OIG reports often results in the Centers for Medicare & Medicaid Services (CMS) emphasizing compliance in the areas identified by OIG as problematic. In the last decade, we have seen everything from skilled nursing therapy payment reform to new emergency preparedness requirements come on the heels of OIG reports.


Infection Prevention and Control & COVID-19

Not surprisingly, in the midst of the COVID-19 pandemic, OIG added multiple items to its Work Plan that relate to how nursing homes and home health agencies have performed against regulatory expectations, including related to specific guidance issued during the COVID-19 Public Health Emergency (PHE).


Psychotropic Drug Use

Despite the strides that nursing homes have made to reduce the prescribing of antipsychotics to residents, a concern remains that some providers may be inappropriately using one of the handful of acceptable diagnoses for the use of antipsychotics in nursing homes. Late-life onset of schizophrenia? Not likely. However, approved diagnoses include Huntington’s Disease, Tourette’s Syndrome and schizophrenia. In 2012, OIG published a report (using a sampling of data from 2007) that found that 99% of records it reviewed failed to meet one or more of the Federal requirements for resident assessments or care plans for residents receiving atypical antipsychotic drugs.  OIG had initially listed a second report related to nursing home antipsychotic drug use as part of its 2013 Work Plan, but it appeared to have been axed mid-way through 2013. Now it’s back on the table, albeit with a more specific focus.

OIG will be trying to determine if nursing home residents who have been prescribed psychotropic meds have the appropriate diagnoses that would exclude them from being counted in the antipsychotic quality measure.

In the second report, OIG will be looking at how the following items have changed over time – use of psychotropic meds for elderly residents, citations and civil monetary penalties (CMPs) assessed regarding psychotropic drugs and the presence of the exclusionary diagnoses mentioned previously.

  • Monitoring Psychotropic Drug Use in Nursing Homes (May 2020) – OIG is reviewing if there are inconsistencies between Medicare claims data for nursing home residents prescribed psychotropic drugs and nursing homes’ self-reported data on residents who have received psychotropic drugs and Medicare claims data regarding diagnoses that would exclude residents from monitoring in the antipsychotic quality measure.
  • Assessing Trends Related to the Use of Psychotropic Drugs in Nursing Homes (July 2020) – OIG will review CMS’s progress towards reducing the use of antipsychotic drugs in elderly nursing home residents by reviewing changes over time related to usage trends, citations and CMPs given related to psychotropic drugs, and whether there has been a change in the presence of exclusionary diagnoses that would impact how CMS measures antipsychotic drug use.

Facility-Initiated Discharges

Long-Term Care Ombudsmen have identified in the past that facility-initiated discharges are more common than one would think, and OIG plans to review the extent to which nursing homes are compliant with the requirements for this type of discharge.


Nursing Home Staffing

Another continued area of focus for regulators and the media is nursing home staffing levels. When the Requirements of Participation (RoPs) for nursing homes were updated a few years back, additional regulations were included related to staff sufficiency. CMS also implemented the use of the auditable Payroll-Based Journal (PBJ), which has since been used to calculate staffing levels. The staffing review that OIG is conducting will look at the data that has been submitted to the PBJ and how CMS is ensuring that data is accurately reported.

  • Nursing Facility Staffing: Reported Levels and CMS Oversight (May 2020) – OIG will be putting out two data briefs on nursing home staffing data. One report will describe the staffing levels reported to the Payroll-Based Journal by nursing homes. The second part of the report will review CMS’s efforts to ensure that the staffing data submitted is accurate and what efforts CMS is making to improve resident quality of care. This report, which was originally announced in early 2019 (with an expected issue date of FY 2020), appears to have been pushed back.

OIG added a Work Plan item in January 2021 with an expected issue date of FY 2022 related to Background Checks for Nursing Home employees.


CMS & State Agency Oversight

Don’t worry, it’s not just the providers who are under OIG’s microscope. OIG will be reviewing several aspects of CMS’s work as well, namely its oversight of contracted State Survey Agencies (SAs) and the accuracy of the publicly available data listed on Care Compare. For the majority of 2020, there was limited information on Nursing Home Compare due to the changes to survey & certification activities related to the COVID-19 PHE. That meant that anyone who was looking to use Nursing Home Compare to find care for a relative or loved one was provided with old data that would not represent an accurate picture of the care currently being provided in a particular nursing home.

One item removed from the OIG Work Plan, which was expected in FY 2020, was the Skilled Nursing Facility Adverse Event Screening Tool.


Read the full OIG Work Plan here.


Reach out today and let's get started!

Urgent Compliance Concern? Call CMSCG

(631) 692-4422
cmscg podcast. five-star quality

Contact CMS Compliance Group

© 2011-2024 CMS Compliance Group, Inc. All Rights Reserved.