In Spring 2022’s Semiannual Report to Congress (SAR), the Department of Health and Human Services’ Office of Inspector General (HHS-OIG) reported that nearly $3 billion had been misspent on Medicare and Medicaid services. Further, the HHS-OIG reported on enforcement actions taken against criminal activities affecting human health services. The report also included civil lawsuits and settlements. The HHS has barred individuals tied to criminal or uncivil activity from participating in Federal healthcare programs.
Christi A. Grimm, Inspector General of the HHS, explained the importance of the SAR. Through in-depth analysis, HHS is able to point out concerning trends occurring in the healthcare field. Then, they are able to offer recommendations to improve the infrastructure of the healthcare industry. This includes recommending compliance programs or trainings for staff. By analyzing fraud, waste, and abuse occurring in the medical system, the HHS is able to put regulations in place to minimize risks for patients and providers.
HHS Examines Medicare Spending and COVID-19 Tests
The SAR showed that there was an overall increase in Medicare Part B spending on laboratory testing. This is due to the large amounts of COVID-19 tests that were administered in 2020. Additionally, the report found that spending on laboratory tests unrelated to COVID-19 decreased dramatically. This highlights some of the effects the coronavirus pandemic had on healthcare infrastructure. Further, professionals are concerned about the decrease in non COVID-19 related tests, as this could potentially lessen the quality of medical care given.
Increased Telehealth Services
In the SAR, it was stated that a large percentage of Medicare beneficiaries continued seeing their regular providers through the use of Telehealth services. While some had previously visited their doctors in person, the use of Telehealth for medical services has increased since the pandemic.
HHS Concerned About Quality of Nursing Homes
The HHS-OIG reported that over 50% of US states failed to meet adequate quality measures in the monitoring and managing of nursing homes for 3-4 years. States are typically required to complete surveys that measure the quality of care given to patients. However, a large proportion of states failed to complete these surveys in a timely manner.
The Centers for Medicare and Medicaid Services (CMS) required states with incomplete surveys to submit plans listing corrective measures. Unfortunately, several corrective action plans were lacking appropriate details or altogether missing. While the CMS has attempted to contact State officials regarding these problems, no formal regulations have been enacted.
Get Certified
American Medical Compliance (AMC) is a leader in the industry for compliance, Billing, and HR solutions. Educate staff on preventing and reporting inappropriate workplace practices by taking AMC’s “Combating Fraud, Waste, and Abuse Training for Healthcare Providers.” Visit www.americanmedicalcompliance.com for more information.
Refernces
U.S. Department of Health and Human Services Office of Inspector General (2022, June 6). America’s taxpayers could recoup nearly $3 billion in misspent Medicare, Medicaid, and other health and human services funds as a result of work by HHS-OIG. Retrieved from: https://oig.hhs.gov/newsroom/news-releases-articles/2022-spring-sar/
