Nursing homes and skilled nursing facilities (“SNF”) should be aware that they will be in the crosshairs of the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) in 2017. As part of this year’s Annual Work Plan, OIG has identified several high priority focus areas, including failure to properly investigate complaints and report incidents, adequate use of the Minimum Data Tool Set, and various reimbursement-related subjects.

Referencing a 2006 OIG report on the failure to timely investigate serious complaints, OIG signaled that it will conduct a new investigation to closely scrutinize facilities’ compliance with two key timelines, 1) the requirement that facilities investigate “actual harm” complaints within ten days and 2) “immediate jeopardy” complaints within two days. The investigation will focus on both the number of complaints as well as the timeliness of facilities’ investigations. As an increase in on-site investigations can be expected in conjunction with this report, facilities are advised to review and update their policies and procedures, and to undertake staff training and internal audits in this high-profile subject area.

The 2017 Work Plan also identifies a new investigation area for skilled nursing facilities: unreported incidents of potential abuse and neglect. OIG intends to “sample” facilities to assess the rate at which incidents of abuse and neglect have been properly reported and investigated. This assessment will be followed up with OIG interviews of state officials, as well as a determination of whether the state agency properly investigated and prosecuted facilities’ failure to timely report. Thus, facilities can expect an increase in state agency investigation and prosecution related to this topic.

The 2017 Work Plan also focuses on facilities’ use of the Minimum Data Tool Set, as well as continuing its emphasis on the upcoding of therapy services. OIG will also analyze hospital transfers related to potentially preventable conditions to assess compliance with residents’ care plans. Additionally, OIG intends to issue a report on the Skilled Nursing Facility (SNF) adverse event trigger tool it believes will help facilities better avoid such undesirable outcomes.

Nursing facilities and SNFs face razor-thin margins in today’s reimbursement environment, and must astutely manage overhead costs to remain solvent. However, with the increased scrutiny such facilities have come under in the last few years, the development of an effective compliance program that addresses key focus areas is a small investment that can pay large dividends when the OIG comes to call.

To learn more about the OIG priority focus areas and assistance to develop an effective compliance program for your organization or other business or health care-related matters, please contact Attorney Joel K. Goloskie at 401-824-5100 or email [email protected]. We welcome your comments, questions and suggestions.