As you may know, the Office of Inspector General (OIG) has moved away from its annual and semiannual Work Plan publications, and now updates the OIG Work Plan on a more frequent basis throughout the year to meet its priorities and to respond to developing issues. In August 2019, the OIG updated its Work Plan to include an item entitled “Nursing Homes: CMS Oversight of State Survey Agencies.” The OIG has recently identified “problems in State Agency performance, including not verifying whether nursing homes corrected deficiencies and not investigating complaints in a timely manner,” which prompted the addition of this item to the Work Plan.

As part of the OIG’s evaluation of Centers for Medicare & Medicaid Services (CMS), the OIG’s Office of Evaluation and Inspections will conduct interviews and review supporting documentation regarding CMS’s monitoring of state agencies. The focus will be on whether CMS is ensuring that state agencies are fulfilling their survey responsibilities. If and when a state agency has an inadequacy, CMS may require additional training of the state agency’s survey teams or require the state agency to submit a corrective action plan. CMS also has the ability to sanction state agencies by reducing federal financial contributions. Providers may not immediately see any changes or feel any impact from this new Work Plan item, but this evaluation could result in changes with state agencies’ performance, depending on the Office of Evaluation and Inspections’ findings, which are expected in Fiscal Year 2020.

Also added to the Work Plan in August is an item entitled “Medicare Part B Services to Medicare Beneficiaries Residing in Nursing Homes During Non-Part A Stays.” The OIG has identified a risk for fraudulent, excessive, or unnecessary Part B billing for services provided to nursing facility residents, “because nursing homes may not be aware of the services that the providers bill directly to Medicare, and because nursing homes provide access to many beneficiaries and their records.” As part of the OIG’s Office of Audit Services’ review of this item, it will be looking at whether nursing facilities “have effective compliance programs and adequate controls over the care provided to their residents.”

Other “Recently Added” Work Plan items can be reviewed here: https://oig.hhs.gov/reports-and-publications/workplan/updates.asp

Should you have any questions or concerns, or would like the Kitch firm’s assistance with preparing for any of the Work Plan items, please contact a member of the Post-Acute Care Practice Group.

OIG Work Plan: August 2019

Key Contacts

Related Services