Good morning to all from Washington, DC. Today OIG posts reports and provides news about enforcement actions. As always, you can use the links provided to go directly to the new material. Report Recap
Oversight of Quality of Care in Medicaid Home and Community Based Services Waiver Programs (OEI-02-08-00170)WHY WE DID THIS STUDYIn recent years, States have altered their approach to providing Medicaid-funded long-term care services. Rather than providing the majority of that care in institutions-such as nursing homes-States are now providing more care in homes and other community-based settings. States most often provide this care through 1915(c) home and community-based services (HCBS) waiver programs, and the individuals served by these programs are most commonly disabled and/or over age 65. In fiscal year 2010, Medicaid expenditures for HCBS waiver programs serving this population totaled an estimated $8.9 billion. Strong oversight of waiver programs is critical to ensuring the quality of care provided to HCBS beneficiaries. The beneficiaries who rely on HCBS waiver programs are among Medicaid's most vulnerable, and the nature of these programs puts beneficiaries at particular risk of receiving inadequate care. HOW WE DID THIS STUDYStates must operate their HCBS waiver programs in accordance with certain "assurances," including three assurances related to quality of care. To meet these assurances, States must demonstrate that they have systems to effectively monitor the adequacy of service plans, the qualifications of providers, and the health and welfare of beneficiaries. We based this study on a review of documents from CMS's most recent quality review of waiver programs from 25 States, as well as information gathered from structured interviews with staff from the 10 CMS regional offices. WHAT WE FOUNDSeven of the twenty-five States that we reviewed did not have adequate systems to ensure the quality of care provided to beneficiaries. Although CMS renewed the waiver programs in all seven of these States, three did not adequately correct identified problems. Not only did these States fail to correct these problems before renewal of their programs, they also had still not adequately addressed the problems long after renewal. In addition, CMS did not consistently use the few tools it has to ensure that States correct problems related to quality of care. WHAT WE RECOMMENDWe recommend that CMS:
CMS concurred with four of the recommendations and partially concurred with our recommendation to require onsite visits. Use of Electronic Health Record Systems in 2011 among Medicare Physicians Providing Evaluation and Management Services (OEI-04-10-00184)WHY WE DID THIS STUDYWhile discussing a separate, ongoing study on the extent of documentation vulnerabilities of evaluation and management (E/M) services using electronic health record (EHR) systems, officials from the Office of the National Coordinator (ONC) for Health Information Technology expressed interest in getting additional information about physicians' reported use of EHR systems. ONC officials also wanted to know how many and which EHR systems were being used and whether the Medicare physicians in our study were using certified EHR systems to document E/M services. Additionally, CMS may find this information helpful as it continues administering its EHR incentive program. HOW WE DID THIS STUDYUsing Medicare claims data, we drew a random sample of 2,000 physicians from a population of 441,990 who provided at least 100 E/M services in 2010. We asked Medicare physicians whether they currently used an EHR system at their primary practice location and whether they used EHR systems to document E/M services. We also asked Medicare physicians which EHR system they used to document E/M services and whether their system was certified. WHAT WE FOUNDWe found that 57 percent of Medicare physicians used an EHR system at their primary practice location in 2011. Twenty-two percent of physicians first began using EHR systems to document E/M services in 2011, the year that CMS commenced its incentive program. Additionally, three of every four Medicare physicians with an EHR system used a certified system to document E/M services. Finally, although many EHR systems can assist physicians in assigning codes for E/M services, we found that most Medicare physicians manually assigned E/M codes. This report does not contain recommendations. Performance Data for the Senior Medicare Patrol Projects: June 2012 Performance Report (OEI-02-12-00190)WHY WE DID THIS STUDYThis memorandum report presents performance data for the Senior Medicare Patrol Projects. OIG has collected these data since 1997. In July 2010, the Administration on Aging (AoA), which is now part of ACL, requested that OIG continue to collect and report performance data for the Senior Medicare Patrol Projects to support AoA's efforts to evaluate and improve the performance of these projects. OIG currently collects performance data every 6 months and reports the data on an annual basis. HOW WE DID THIS STUDYThis review is based on data reported by the Senior Medicare Patrol Projects. In addition, we requested and reviewed documentation from the projects for the funds recovered to the Medicare program, the Medicaid program, beneficiaries, and others that were attributable to the projects. We also requested and reviewed documentation for the measure of cost avoidance. We did not review documentation for the other performance measures. WHAT WE FOUNDIn 2011, the 54 Senior Medicare Patrol Projects had 5,671 active volunteers, a 14-percent increase from 2010. These volunteers conducted 66,303 one-on-one counseling sessions and 11,109 group education sessions. In 2011, 431,128 beneficiaries attended group education sessions, an increase from 298,097 in 2010. At the same time, Medicare funds recovered that were attributable to the projects were $19,283 in 2011. Total savings to Medicare, Medicaid, beneficiaries, and others were $32,941. Additionally, cost avoidance on behalf of the Medicare program, the Medicaid program, beneficiaries, and others, totaled $247,850. One of the projects, however, reported referring two large-dollar cases to a Medicare contractor. In one of these cases, the Medicare contractor is seeking to recover $2.9 million in overpayments from a provider who was identified by the project. We continue to emphasize that the number of beneficiaries who have learned from the Senior Medicare Patrol Projects to detect fraud, waste, and abuse and who subsequently refer cases to Medicare contractors or law enforcement entities cannot be always be tracked. Therefore, the projects may not be receiving full credit for savings attributable to their work. In addition, the projects are unable to track substantial savings derived from a sentinel effect whereby fraud and errors are reduced by Medicare beneficiaries' scrutiny of their bills. This report does not contain recommendations. Corporate Integrity Agreement Update - Two CIAs ClosedFederal Enforcement Action UpdatesJune 20, 2012; U.S. Attorney; Western District of Oklahoma June 20, 2012; U.S. Attorney; Western District of Oklahoma That's all we have for today. If we can be of any further assistance, please send an Email to public.affairs@oig.hhs.gov Have a great weekend! Dee Ellison - Office of External Affairs OIG’s privacy policy can be found at http://oig.hhs.gov/notices/privacy-notice.asp
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OIG Posts 3 Reports, 2 Closed CIAs, Enforcement Action Updates - 6/22
