Category Archives: Social Security Act

OIG Report Shows Many Incidents of Potential Abuse or Neglect Unreported in SNFs

The U. S. Department of Health and Human Services (HHS), Office of Inspector General (OIG) recently published an Early Alert report regarding the preliminary results of an ongoing study of potential abuse or neglect in Medicare-certified Skilled Nursing Facilities (SNFs). In the report dated August 24, 2017, the OIG determined that the Centers for Medicare & Medicaid Services (CMS) has inadequate procedures to ensure that incidents of potential abuse or neglect of Medicare beneficiaries residing in SNFs are properly identified and reported. The OIG audit is continuing, but the preliminary results were issued because of the importance of detecting and combating elder abuse. Continue reading

Conducting Required Reviews Can Save Your Facility from Embarrassment – and Worse!

Even though we know the old saying “an ounce of prevention is worth a pound of cure,” background checks on on personnel can sometimes fall through the cracks. Here are a few examples of times that make us wish we would have double-checked to be sure they were getting done:

  • A state surveyor is on-site investigating and advises that the allegation of neglect or abuse is against a tech who was convicted for beating up his father a year before he was hired.
  • In employing a favorite PRN nurse who has been around for a couple of years, you learn that she never obtained a license when she moved here from Texas. You realize there may now be returnable overpayments, because she is not appropriately licensed to perform the services in our state.
  • You want to impress your new venture partner, and cringe when they discover in due diligence that your team has not checked the excluded provider or debarred contractor lists in a few years.

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Final Rule Released to the OIGs Exclusion Authorities

On January 11, 2017, the Office of Inspector General (OIG) of the Department of Health and Human Services released a final rule that incorporates statutory changes, early reinstatement provisions, and policy changes, and clarifies existing regulatory provisions to the OIG’s authorities to exclude persons and entities from participating in Federal health care programs. The Affordable Care Act of 2010 expanded the OIG’s authority to exclude various individuals and entities from participation in Federal health care programs under section 1128 of the Social Security Act (Act). The changes in the final rule to the OIG’s authority were also based on the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), which amended the OIG’s authority to waive certain exclusions under section 1128 of the Act.

A copy of the final rule is available at: http://go.usa.gov/x9Ugu

Written by: Clay J. Countryman

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