OIG: Home Health Agencies Did Not Use Telehealth Early in the COVID-19 Pandemic

A new report from the U.S Department of Health and Human Services’ Office of Inspector General (OIG) found that home health agencies (HHAs) rarely furnished services via telehealth early in the COVID-19 public health emergency. For the few claims in the OIG sample with services furnished via telehealth, HHAs did not fully comply with Medicare […]

Home health leaders decry OIG report revealing fall reporting noncompliance (mcknightshomecare.com)

HHAs Inaccurately Report Falls with Major Injury

On September 5, 2023, the Office of the Inspector General (OIG) issued a report showing that home health agencies (HHAs)failed to report over half of falls with major injury and hospitalization among their Medicare patients. Fifty-five percent of falls we identified in Medicare claims were not reported in associated Outcome and Assessment Information Set (OASIS) […]

OIG Releases Report on Medicaid Managed Care Prior Authorizations

On July 19, the Office of Inspector General (OIG) at the US Department of Health and Human Services released a report detailing concerns about the prior authorization processes used by Medicaid Managed Care Organizations (MCOs). In the report, OIG found that: On average, the reviewed MCOs denied one out of every eight prior authorization requests […]

Hospice General Inpatient Care Focus of New OIG Work Plan Item

The Health and Human Services (HHS) Office of the Inspector General (OIG) updated its Work Plan with a new hospice  item, Audit of Selected, High-Risk Medicare General Inpatient Services.  The Work Plan sets forth various projects including OIG audits and evaluations that are underway or planned to be addressed during the fiscal year and beyond […]

Hospice Survey Process Revised

The long-awaited revised hospice survey process is now available via a recent Quality, Safety & Oversight (QSO) Group memo, QSO-23-08-HOSPICE. The memo updates Appendix M of the Centers for Medicare & Medicaid Services (CMS) State Operations Manual which lays out the hospice survey process and the interpretive guidelines surveyors use to assess a hospice’s compliance […]

Medicare Providers Did Not Always Comply With Federal Requirements When Billing for Advance Care Planning

Medicare providers that billed for advanced care planning (ACP) services in an office setting did not always comply with Federal requirements, according to a new report from the Office of Inspector General (OIG). Specifically, the OIG investigation found that of the 691 ACP services associated with their sample, Medicare providers complied with Federal requirements for […]

OIG: Home Health Responded to COVID Creatively, but Challenges Persist

Key issue of telehealth remains Home health agencies (HHAs) developed strategies to respond to challenges during the COVID-19 pandemic, including providing new incentives to maintain staff and seeking alternative sources of personal protective equipment, finds a new report from the Office of Inspector General (OIG). The report also concluded that HHAs were helped by regulatory flexibilities and expanded telehealth usage, and recommended […]

Hospices Urged to Participate in CMS Pilot to Test Transmission of Hospice Election Data to Part D Plans

For more than a decade, the Centers for Medicare & Medicaid Services (CMS), the Department of Health and Human Services Office of the Inspector General (OIG), and other policymakers have noted with concern the growth in Medicare spending outside of the hospice benefit, while patients are on hospice care. One area of particular concern is […]

Hospices Urged to Participate in CMS Pilot to Test Transmission of Hospice Election Data to Part D Plans

For more than a decade, the Centers for Medicare & Medicaid Services (CMS), the Department of Health and Human Services Office of the Inspector General (OIG), and other policymakers have noted with concern the growth in Medicare spending outside of the hospice benefit, while patients are on hospice care. One area of particular concern is […]