The Office of Inspector General (OIG) is requesting $454.4 million in its fiscal year 2026 budget to continue fighting fraud, waste, and abuse in the U.S. Department of Health and Human Services (HHS) programs, with nursing homes being identified as one of its three main areas of priority, with the reduction of antipsychotic drug use as a key focus.
The other priority areas are Grants and Contracts and Managed Care, the federal watchdog group said in its report of Justification of Estimates for Congress released Friday.
“OIG is committed to protecting nursing home residents and providing oversight of Medicare and Medicaid payments for their care,” OIG stated in the report. “Many homes provide excellent care, but an alarming number of residents are subject to poor quality care and unsafe conditions. Decades of OIG work on nursing homes has uncovered widespread challenges in providing safe, high quality care.”
Nationwide, there are over 15,000 nursing homes serving 1.2 million residents.
Of this budget request, $367.4 million is planned to be designated for oversight of Medicare and Medicaid, and $87 million for other HHS programs, including the National Institutes of Health (NIH), Centers for Disease Control and Protection (CDC), and the Food and Drug Administration (FDA).
“With the requested funding, OIG will continue to stop sophisticated fraud schemes and hold wrongdoers accountable; uncover safety risks; and help provide assurances that enrollees in HHS programs get the services to which they are entitled without waste to taxpayer dollars,” the OIG report noted.
Using advanced analytics, artificial intelligence, and interagency partnerships, OIG’s report stated that the agency has delivered a high return on taxpayer investment to the tune of $11 in recoveries for every $1 spent.
Overall in 2024, OIG’s work led to over $7 billion in expected recoveries across its three areas of priority.
As for nursing homes, OIG’s focus on the sector is driven by long-standing systemic issues in the industry, the agency said, noting some headway made on issues like over use of antipsychotics.
That said, more needs to be done, and OIG plans further evaluations in 2025, including assessments of citations for misuse of antipsychotic drugs.
“[W]e have seen meaningful results, including reductions in use of antipsychotic drugs in nursing homes. However, OIG more recently uncovered evidence that some nursing homes may be exploiting loopholes in CMS’s monitoring and reporting on their antipsychotic drug use,” report states.
The agency also influenced CMS improvements to its Care Compare website, enhancing transparency by adding nurse turnover and weekend staffing data, and prompting audits of non-nurse staffing information.
Also in 2024, OIG released its Industry Segment-Specific Compliance Program Guidance (ICPG) for skilled nursing facilities (SNFs), a voluntary guide consolidating decades of oversight. This resource emphasizes the need for strict compliance and aims to improve care quality and resident well-being while safeguarding public funds.
OIG plans to work with the Department of Justice (DOJ), Medicaid Fraud Control Units (MFCUs), and other law enforcement to identify and prosecute fraud going forward.
