The Office of Inspector General has issued an "early alert" warning that "CMS procedures are not adequate to ensure that incidents of potential abuse or neglect of Medicare beneficiaries residing in [skilled nursing facilities] are identified and reported." In the course an ongoing review, the OIG identified 134 Medicare beneficiaries with injuries resulting from potential abuse or neglect in 2015 or 2016. According to the OIG, 28 percent of these incidents were not reported to local law enforcement. The OIG suggests that CMS take a number of immediate actions to ensure that such potential instances of abuse or neglect are identified and reported, such as comparing Medicare claims for emergency room treatment with claims for SNF services. The OIG also called on CMS to pursue the authority to impose civil monetary penalties and exclusions under Section 1150B of the Social Security Act (which requires certain designated covered individuals in federally funded long-term care facilities to report immediately any reasonable suspicion of a crime committed against a resident of that facility). The OIG plans to make formal recommendations to CMS when its audit is complete.
This article is presented for informational purposes only and is not intended to constitute legal advice.
