OIG Launches Multiple Investigations into Nursing Home Response to COVID-19

The Department of Health and Human Services’ (HHS) watchdog arm added multiple probes of nursing homes’ response to COVID-19 to its list of top 2020 priorities, with a particular focus on infection control.

The HHS Office of the Inspector General (OIG) last Friday announced two coronavirus-related investigations as part of its ongoing 2020 Work Plan — one that focuses on auditing nursing homes’ infection control programs, and another that will analyze the Centers for Medicare & Medicaid Services’ (CMS) oversight efforts during the ongoing pandemic.

Through February 2020, prior to the start of the COVID-19 crisis, CMS’s State Survey Agencies (SSAs) had issued infection-control citations at 6,600 nursing homes, or about 43% of the total facilities in the country, the OIG observed; those deficiencies included both infection-control problems as well as a lack of plans to fix known issues, according to the OIG.

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“To reduce the likelihood of contracting and spreading COVID-19 at these nursing homes, effective internal controls must be in place,” OIG noted. “Our objective is to determine whether selected nursing homes have programs for infection prevention and control and emergency preparedness in accordance with federal requirements.”

CMS moved to refocus its nursing home inspection plan around infection control early in the coronavirus crisis. Early results from the first rounds of post-COVID inspections revealed “sporadic non-compliance” in three main areas of infection protocols, according to CMS officials: hand-washing, proper use of personal protective equipment (PPE), and cohorting.

In a separate investigation, OIG will look into the efficacy of these survey efforts.

“Using recent complaint and survey data for all nursing homes, this study will examine the extent to which SSAs and CMS are conducting onsite surveys in nursing homes related to serious complaints and targeted infection control, in accord with CMS’s recent guidance to suspend certain onsite surveys,” OIG announced. “We will also identify any barriers that CMS and SSAs face in conducting onsite surveys, as well as potential solutions.”

Finally, a third OIG probe will tackle the issue of anti-psychotic drugs in nursing homes, a long-standing topic of concern for regulators and resident advocates.

A coordinated push from CMS helped to reduce the use of such drugs by 34.1% between 2011 and 2017, though CMS administrator Seema Verma has continued to call for further improvements, including the incorporation of data on anti-psychotic drug use on Nursing Home Compare.

Citing both CMS and independent researchers, OIG alleged that some nursing homes may be underreporting their anti-psychotic drug data, while also potentially submitting inaccurate diagnosis information to evade CMS’s oversight.

“We will determine the extent to which there are inconsistencies, if any, between (1) Medicare claims data for residents prescribed psychotropic drugs compared to nursing home self-reported data on residents who received psychotropic drugs, and (2) Medicare claims data as it relates to the diagnoses that exclude residents from monitoring in the antipsychotic quality measure compared to nursing home self-reported data on resident diagnoses,” OIG asserted.

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