Improving nursing home oversight and quality will be “top priority” for the Department of Health and Human Services’ (HHS) Office of Inspector General (OIG), as the Biden administration pushes ahead with its reform initiatives.
“My top priority is propelling meaningful improvement in the quality and safety of care in the more than 15,000 Medicare- and Medicaid-certified nursing homes nationwide,” Christi Grimm, OIG’s Inspector General, wrote in introduction to the organizations’ latest semiannual report to Congress.
OIG plans to “dive deeply” to understand contributing factors in poor nursing home performance and what should be done to improve resident experience, and how frontline oversight can be more effective, according to the report.
“I am confident that the effects of our efforts during the reporting period — which include recommendations to improve nursing home life safety and emergency preparedness, recovery of over a billion dollars in taxpayer funds, and the exclusion of 1,290 individuals and entities from participating in Federal health care programs — resonate throughout all of HHS,” Grimm said in a press release about the report.
Coupled with the focus on nursing homes, OIG said there could be a recoupment of billions in misspent Medicare, Medicaid and other health and human services funds based on work accomplished in fiscal year 2022.
A three-pronged approach was detailed in the report to address better protection of nursing home residents: first, OIG will look into what drives nursing home performance; and second, ensure nursing homes prioritize quality of care and quality of life for residents.
The third prong is OIG’s bread and butter – ensuring agencies responsible for oversight “detect problems quickly and insist on rapid remediation.” OIG refers to the Centers for Medicare & Medicaid Services (CMS) and state agencies.
OIG currently has 21 ongoing audits and evaluations of nursing home issues, according to the report.
One finding tied to Medicare and Medicaid reports and reviews in the OIG report suggests select facilities of operator giant Life Care Centers of America did not comply with infection prevention and control and emergency preparedness.
The operator said possible noncompliance was due to leadership and staff turnover, documentation issues, confusion among staff related to appropriate measures to take, general workforce shortages and challenges tied to the public health emergency (PHE).
“We also believe that many of the conditions noted in our report occurred because CMS did not provide nursing homes with communication and training related to complying with the new, phase 3 infection control requirements, or clarification about the essential components to be integrated in the nursing homes’ emergency plans,” according to the OIG report.
MorseLife Health Systems Inc. was named in the OIG report as well for its agreement to pay $1.75 million to resolve potential liability under the False Claims Act – the operator facilitated hundreds of Covid vaccinations for people ineligible to receive shots through the Centers for Disease Control and Prevention (CDC) Pharmacy Partnership for Long-Term Care (LTC PPP).
The West Palm Beach, Fla. provider operates a nursing home and assisted living facility on its campus.
OIG mentioned New York-based Plaza Rehab and Nursing Center and Citadel Consulting Group in its kickback reports – the operator and consultant settled for $7.85 million in a civil False Claims Act lawsuit.
Plaza, at the request of Citadel, fraudulently switched the type of Medicare coverage for residents to maximize reimbursements, according to OIG.
OIG’s exclusions section of its report, which outlines entities and individuals that were kicked off of Medicare, Medicaid and other Federal health care programs when they pose a risk to the people they serve, included the seven facilities owned by Bob Glynn Dean Jr. in Louisiana.
After the nursing homes were evacuated during Hurricane Ida, more than 800 residents were put in a single warehouse – subjected to inhumane conditions involving mattresses sitting in standing water – and seven eventually died.
In a wider audit of nursing home life safety and emergency preparedness across eight states, a total of 2,233 areas of noncompliance were identified by OIG in its report, at 150 of 154 nursing homes the agency visited.
OIG made a flurry of recommendations to CMS to address these findings, including requiring nursing homes to install carbon monoxide detectors and asking states to encourage mandatory participation in direct care staff standardized training.