Several specific audits revealed significant issues, including improper payments to hospitals, inadequate infection prevention in nursing homes, and insufficient data on child maltreatment in foster care facilities.
America’s taxpayers could see recoupment of billions of dollars in misspent Medicare, Medicaid, and other health and human services funds as a result of work by the Department of Health and Human Services (HHS), Office of Inspector General (OIG), according to a new report.
…Additional highlights of HHS-OIG’s work in the SAR include:
Certain For-Profit Nursing Homes May Not Have Complied With Federal Requirements Regarding the Infection Preventionist Position. OIG reviewed 100 for-profit nursing homes nationwide and found that 24 did not meet Federal requirements pertaining to infection preventionists. Infection preventionists are responsible for facility infection prevention and control. Based on our sample results, OIG estimates that 2,568 (approximately 1 in 4) for-profit nursing homes nationwide may not have complied with Federal requirements for infection preventionists during our review period. As a result, there may be increased health and safety risks for the residents and staff of these nursing homes. (See report A-01-22-00001.)
HHS-OIG’s efforts result in $7.13 billion in expected recoveries and receivables, according to Fall 2024 semiannual report. (2024, December 4). Office of Inspector General | Government Oversight | U.S. Department of Health and Human Services. https://oig.hhs.gov/newsroom/news-releases-articles/hhs-oigs-efforts-result-in-713-billion-in-expected-recoveries-and-receivables-according-to-fall-2024-semiannual-report/
Report on For-Profit Nursing Homes Lack of Compliance with Infection Prevention (PDF)
Improve Medicare Advantage reimbursements with payer contract management that puts payer rules in the hands of clinicians & billers.
