Long Term Care and Senior Housing Hot Sheet -Breaking Developments in Long Term Care and Senior
Housing Law
12.7.2005
Office of Inspector General Releases
2006 Work Plan--What Nursing Homes Should Know
On November 16, 2005, the U.S. Department of Health and Human Services' Office of Inspector General
("OIG") released its 2006 Work Plan. The focus of the OIG is to watchdog governmental health programs
and operations by "protecting them against fraud, waste, and abuse." The OIG's duties are carried out
through a nationwide network of audits, investigations and inspections. Accordingly, when the OIG
speaks, nursing homes should listen.
The OIG's annual Work Plan provides a preview of its priorities for fraud and compliance enforcement
for the new year, making it a valuable planning tool for nursing homes. (A complete copy of the Work
Plan is available at www.oig.hhs.gov/publications/workplan.html.) While numerous projects and
initiatives are included in the Work Plan, some are general in nature (for example, auditing whether
states are effectively enforcing federal regulations), but other OIG initiatives "drill down" on specific
and discrete areas or services. When reviewing the Work Plan, providers should pay particularly close
attention to these "drill down" areas because they represent concrete targets for improving their own
compliance plans.
With this in mind, each nursing home should scrutinize its provision of the following services found in
the 2006 Work Plan:
•
Rehabilitation and Infusion Therapy Services. The OIG will analyze whether rehabilitation and
infusion therapy services provided to Medicare beneficiaries in skilled nursing facilities were
medically necessary, adequately supported, and actually provided as ordered.Call your
attorney or corporate counsel immediately.
•
Imaging and Laboratory Services in Nursing Homes. The OIG will determine the extent and
nature of any medically unnecessary or excessive billing for imaging and laboratory services
provided to nursing home residents.
•
Consecutive Inpatient Stays. The OIG will determine whether nursing home care to Medicare
beneficiaries with consecutive inpatient stays was medically reasonable and necessary. The
study will focus on beneficiaries who experience three or more consecutive stays, including at
least one skilled nursing facility ("SNF") stay.
While the topic of "billing" is always found in the Work Plan, nursing homes should be especially aware
of two specific aspects of their billing:
•
Payments for Day of Discharge. Medicare regulations state that the day of discharge is not a
day of billable services for SNFs. The OIG will determine if Medicare is inappropriately paying
SNFs for services on the day of discharge.
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•
Consolidated Billing. The OIG will determine whether controls are in place to preclude
duplicate billings under Medicare Part B for services covered under the SNF prospective
payment system.
Nursing homes need to be vigilant in their efforts to comply with federal and state rules across the
board. As part of a comprehensive compliance plan, nursing homes must be aware of the fundamental
concerns of the OIG and all items on its Work Plan.* However, adapting compliance plans to anticipate
regulatory initiatives can best be achieved by an understanding of the specific areas of concern by the
OIG for 2006. Making compliance improvements in the categories listed above would be a prudent way
to start the New Year.
___________________________
*
In addition to the issues listed above, the following nursing home issues are also included in the 2006
Work Plan: Use of Additional Funds Provided to SNFs; Nursing Home Deficiency Trends; Nursing Home
Residents Minimum Data Set Assessments and Care Planning; Enforcement Actions Against
Noncompliant Nursing Homes; State Compliance with Complaint Investigation Guidelines; Prescription
Drug Plan Formularies and Dually Eligible Nursing Home Residents.
For more information, please contact the Long Term Care and Senior Housing Law Practice
Group at:
Lane Powell PC:
(206) 223-7000 Seattle
(503) 778-2100 Portland
(360) 754-6001 Olympia
longtermcareandseniorhousing@lanepowell.com
www.lanepowell.com
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