Get Your Monthly OIG Work Plan Scoop for March 2022

Get Your Monthly OIG Work Plan Scoop for March 2022

Posted by CJ Wolf
Apr 12, 2022 2:30:00 PM

Hello folks! Many new items were added to the OIG’s Work Plan in March. Let’s look at some of the items in greater depth.

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Data Mining by Medicaid Fraud Control Units

In Missouri, a Medicaid Fraud Control Unit obtained a $150,000 settlement from a residential care facility owner for false billing services. The owner filed false claims for personal care and nursing services that her facility did not provide and could not produce documentation to prove certain services were provided, including plans of care for the recipients, daily service logs of personal care, and written notes by nurses regarding on-site visits or annual personal care aide assessments.

In Ohio, a Medicaid Fraud Control Unit was involved in a case resulting in the conviction of a physician who illegally dispensed controlled substances, and up-coded office visits billed to Medicaid. The physician was ordered to pay over $26,000 and sentenced to 96 months in federal prison.

These are just two examples of the work performed by state Medicaid Fraud Control Units (MFCU). With a newly added work plan item, the OIG wants to know how the MFCUs throughout the country can use data mining to continue accomplishing such work.

Since 2013, MFCUs have had the option to apply to OIG for approval to use data mining. OIG feels data mining could improve MFCUs’ ability to identify potential fraud and patient abuse or neglect cases and more effectively target their resources to significant areas of vulnerability.

With this work, the OIG will examine MFCUs’ experiences in implementing and using data mining, including any challenges and specific successes. We will also evaluate the outcomes of their activities.

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COVID-19 Vaccination Status of Nursing Home Staff

Throughout the COVID pandemic, many news reports highlighted how severely residents of nursing homes had been affected. Reports also highlighted the debates and arguments about mandatory vaccination, especially among healthcare workers.

Because nursing home residents are disproportionately represented in the number of COVID-19-related deaths in the United States, vaccination among nursing home staff is very important. Data reported by nursing homes to the Centers for Disease Control (CDC) showed that COVID-19 infections among nursing home residents were higher in nursing homes with lower vaccination coverage among staff. The data also indicates that while nursing homes have made significant progress in vaccinating their residents, approximately one in five nursing home staff were not vaccinated as of the end of 2021.

According to newly changed federal regulations, nursing home staff must be fully vaccinated against COVID-19. The regulations allow nursing homes to grant staff exemptions from the vaccination requirements based on Federal law (e.g., for specific medical and religious reasons). The regulations also require nursing homes to track and document the vaccination status of staff, exemptions requested, and exemptions granted. Though the effective date of the regulations varies by State, all States must comply by March 21, 2022. With this in mind, the OIG plans a series of audits, through which they will determine whether nursing homes are in compliance with the regulations and identify the COVID-19 vaccination status of their staff members.

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2021 Performance Data for the Senior Medicare Patrol Projects

As healthcare compliance professionals, we have often heard of the billions of federal dollars lost annually due to healthcare fraud, errors, and abuse–this is probably a significant reason why healthcare compliance jobs exist in the first place. It is not just full-time employed compliance professionals looking for potential Medicare fraud, waste, and abuse. Retired seniors are also enlisted.

The Senior Medicare Patrol (SMP) is a government-funded program designed to recruit and train retired professionals and other volunteers to recognize and report instances or patterns of healthcare fraud. The SMP’s mission is to empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report suspected healthcare fraud, errors, and abuse through outreach, counseling, and education. The program is run by the Administration for Community Living, and more can be learned about the program here.

Each year, OIG completes an annual performance report on the SMP projects. A previous OIG report for one year shared the following:

    • Community Outreach Events: SMP projects reached 1.6 million people through 28,146 group outreach and education events.
    • One-on-One Counseling: SMP projects held more than 320,590 individual counseling sessions with, or on behalf of, Medicare beneficiaries regarding potential fraud, errors, or abuse.
    • Expected Medicare Recoveries: SMP Projects reported $2.4 million in expected Medicare recoveries.
    • Consumer Fraud Alerts: SMP released a consumer fraud alert on genetic testing. This alert advises beneficiaries to be suspicious of strangers who offer free genetic tests, be cautious about sharing their personal information, and warns that personal data can be used to bill Medicare and Medicaid fraudulently.

With this Work Plan item added in March 2022, the OIG will produce the next annual report with performance data for the Senior Medicare Patrol projects.

Conclusion

These are just a few newly added items to the OIG’s Work Plan. Take a moment to think of the trickle-down effects these projects could have on your organization and compliance program. Then, be appropriately proactive in your compliance efforts.

 

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