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08/14/2019

Update on the OIG Report on Potential Abuse or Neglect of Patients

Earlier in July, the Office of the Inspector General (OIG) released a report, CMS Could Use Medicare Data to Identify Instances of Potential Abuse or Neglect, discussing how the OIG identified potential cases of abuse or neglect utilizing diagnosis codes on claims for beneficiaries treated in emergency rooms. In this report, the OIG also identified that not all cases of potential abuse or neglect were reported as required. In addition to this report, the OIG also recently released A Resource Guide for Using Diagnosis Codes in Health Insurance Claims To Help Identify Unreported Abuse or Neglect.

The OIG stated it created this guide to support partners such as State Medicaid Fraud Control Units, Survey Agencies, Adult and Child Protective Service Agencies, as well as compliance and risk management officials working at insurance providers, hospitals, nursing homes and group homes to develop their own unique processes for analyzing claims data to help identify:

  • unreported instances of abuse or neglect;
  • beneficiaries or patients who may require immediate intervention to ensure their safety;
  • providers exhibiting patterns of abuse or neglect; and
  • instances in which providers did not comply with mandatory-reporting requirements.

The Guide breaks down key decision points to help identify unreported incidents of abuse/neglect to help partners in analyzing claims data. In addition, the guide includes links to OIG’s and other agencies’ reports that address abuse and neglect and links to other useful websites. An organization or partner (state survey agency or provider, for instance) could use the Guide to develop a strategy unique to its population to aid in identifying unreported potential abuse or neglect and then develop ways to address it.

For questions on the OIG report or the resource guide, please contact Anne Shelley at ashelley@leadingageohio.org.

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