Good morning to all from Washington, DC. Today OIG posts a report and provides news about enforcement actions. As always, you can use the links provided to go directly to the new material. ------------------------------------------------------------------------------ Nursing Facility Assessments and Care Plans for Residents Receiving Atypical Antipsychotic Drugs (OEI-07-08-00151) http://go.usa.gov/wpX WHY WE DID THIS STUDY Nursing facilities must meet Federal quality and safety standards to participate in the Medicare and/or Medicaid programs. The standards require extra protections for nursing facility residents receiving antipsychotic drugs. Nursing facility staff are required to assess each resident’s functional capacity upon admission to the facility and periodically thereafter. Staff must specify in a written care plan, based on these assessments, the services that each resident needs. CMS contracts with State agencies to ensure that nursing facilities comply with the standards for resident assessments and care plans. HOW WE DID THIS STUDY This study used a random sample of records from a previous OIG study of elderly nursing facility residents with Medicare claims for atypical antipsychotic drugs between January and June 2007 (OEI-07-08-00150). We reviewed the records for evidence of compliance with Federal requirements for resident assessments and documentation of decision making. We also reviewed the records for evidence of compliance with Federal requirements for care plan development and implementation. WHAT WE FOUND Nearly all records reviewed (99 percent) failed to meet one or more Federal requirements for resident assessments and/or care plans. The resident assessment and care plan process involves four steps. One-third of records reviewed did not contain evidence of compliance with Federal requirements regarding resident assessments, the first step. Further, for 4 percent of records, nursing facility staff did not document consideration of the Resident Assessment Protocol for psychotropic drug use as required, the second step. Ninety-nine percent of records did not contain evidence of compliance with Federal requirements for care plan development, the third step. Finally, 18 percent of records reviewed did not contain evidence to indicate that planned interventions for antipsychotic drug use—the fourth step—actually occurred. WHAT WE RECOMMEND We recommend that CMS: (1) Improve the detection of noncompliance with Federal requirements for resident assessments and care plans for residents receiving antipsychotic drugs, (2) Take appropriate action to address noncompliance with these requirements, and (3) Provide methods for nursing facilities to enhance the development and usefulness of resident assessments and care plans. CMS concurred with all of our recommendations. ------------------------------------------------------------------------------ June 28, 2012; U.S. Attorney; Southern District of Iowa Council Bluffs Area Nursing Home Reaches Settlement Agreement on Allegations of Fraudulent Billing to Medicare for Physical, Occupational and Speech Therapy Services http://go.usa.gov/yWn ------------------------------------------------------------------------------ State Enforcement Actions Updated http://go.usa.gov/pqp ------------------------------------------------------------------------------ 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 I hope your week has started well. Marc Wolfson – 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 Report and News about Enforcement actions - 7/9
