The OIG’s 2013 Work Plan Also Targets Post-Acute Providers

In the Press · November 26, 2012

In our last alert, we
discussed The Office of the Inspector General (OIG) 2013 Work Plan as it
impacts hospitals and physician practices. There are, however, a number of new
items on the OIG’s list that directly affect nursing homes, hospices, and
home health providers
. Providers can expect surveyors to focus on these
items when they conduct surveys for compliance with federal Medicare and
Medicaid requirements.  Below are some of the highlights from the OIG’s
work plan:

Nursing
Homes

Use
of Atypical Antipsychotic Drugs (New)

The OIG
will assess the administration of atypical antipsychotic drugs in nursing homes
and examine the characteristics of nursing homes that frequently administer
these types of drugs. Nursing homes are advised to review their policies and
procedures related to the administration of antipsychotic drugs to ensure
compliance with state and federal requirements.

Communicable
Disease Care (New)

The OIG
will examine whether claims submitted by nursing homes for communicable
diseases meet state and federal requirements and whether patient safety is
adversely affected as a result of the failure to comply with state and federal
requirements.

Adverse
Events in Skilled Nursing Facilities (SNFs)

The OIG
intends to investigate the incidence of adverse events and temporary harm to
Medicare beneficiaries receiving post-acute care in SNFs, identify contributing
factors, determine whether the events were preventable, and estimate the
associated costs to Medicare.

Medicare
Requirements for Quality of Care

The OIG
will examine the use of the Residential Assessment Instrument to develop care
plans and any instances of poor quality care, including whether
hospitalizations of nursing home residents were the result of preventable or
manageable conditions. The OIG also intends to identify poorly performing
nursing homes.

Hospices

Marketing
Practices and Financial Relationships between Hospices and  Nursing
Facilities

The OIG
plans to conduct a review of hospices’ marketing practices and financial
relationships with nursing facilities, focusing on hospices that have a high
percentage of their beneficiaries in nursing facilities. In a previous report,
the OIG found that 82% of hospice claims for patients in nursing facilities did
not meet Medicare coverage requirements.

Hospice
Inpatient Care Claims – Review of Hospice Medical Records

The OIG
intends to review hospice medical records and hospice inpatient care claims to
determine whether they comply with Medicare conditions of participation for
inpatient hospice care.

Home
Health Agencies

Face-To-Face
Encounter Requirements for Home Health Agencies (New)

The OIG
will investigate home health agencies’ (HHAs) compliance with the statutory
requirement of a face-to-face encounter with a physician (or certain
practitioners) to certify that beneficiaries are eligible for home health
services under the Medicare program. It is important that HHAs comply with the
statutory requirement and that the encounter is documented in the beneficiary’s
medical record.

Employment
of Home Health Aides with Criminal Convictions (New)

The OIG
will determine HHAs’ compliance with state and federal requirements related to
conducting criminal background checks on HHA applicants and employees.

If
you have questions about the OIG’s Work Plan, or any concerns regarding your
organization’s compliance with the items in the Work Plan, please contact Rochelle
H. Zapol
, a partner in Prince Lobel’s Health
Care Practice
and the author of this Alert. You can reach Rochelle
at 617 456 8036 or rzapol@princelobel.com.
Rochelle has extensive experience in Medicare compliance issues and has
assisted post-acute providers in establishing policies and procedures to comply
with Medicare requirements.