• E-mail
• Print
• RSS

Gov’t audit insider: Substandard-care denials come under OIG’s watchful eye

Healthcare Auditing Weekly, April 27, 2004

The Office of Inspector General (OIG) is taking a fresh look at whether state Medicaid programs are appropriately denying payments to nursing homes guilty of providing substandard care. The OIG wants state programs to step up and enforce mandatory payment denials for sub-par care, which means that if your facility isn't providing quality care, you're flirting with denials disaster.

To determine whether the state of Massachusetts had adequate controls to ensure mandatory denial of payments for substandard care, the OIG did the following during an audit:

• Identified nursing homes sanctioned for substandard care
• Compared this list to Centers for Medicare & Medicaid Services' reports of nursing homes under the denial of payment sanction
• Identified any improper payments made to sanctioned nursing homes during the audit period and verified those payments using state records
• Visited seven nursing homes that accounted for the majority of overpayments, and verified dates of admission for residents

So far, Massachusetts' Medicare program's denial track record came under investigation in an audit report released April 23, and Indiana got a good report when its program underwent inspection in a report released April 21. 

Click here to view the audit of Massachusetts' mandatory denials.

• E-mail to a Colleague
• Print
• RSS
• Archive