Report on Medicare Compliance 31 no. 18 (May 16, 2022)

◆ In a new report, the HHS Office of Inspector General (OIG) said 25% of Medicare beneficiaries experienced patient harm (adverse events and temporary harm events) during hospital stays in October 2018, slightly down from 27% in October 2008.^[1] The most common patient harm events related to medication (e.g., delirium), followed by events related to patient care (e.g., pressure ulcers), procedures and surgeries (e.g., intraoperative hypotension) and infections. “Given the scale and persistence of patient harm in hospitals in the decade since our last report, HHS leadership and agencies must work with urgency to reduce patient harm in hospitals,” OIG said. The report includes recommendations for CMS and the Agency for Healthcare Research and Quality to reduce patient harm.

◆ CMS has posted its first new proposed audit target in months for recovery audit contractors.^[2] It’s for hypoglossal nerve stimulation for obstructive sleep apnea (medical necessity and documentation requirements).

◆ SHC Home Health Services of Florida LLC and its related entities (collectively Signature HomeNow) have paid $2.1 million to settle false claims allegations in connection with home health services provided in Florida, the U.S. Attorney’s Office for the Southern District of Florida said May 9.^[3] The case was set in motion by two whistleblowers who are former nursing directors for the defendants. According to the complaint and the settlement, between 2013 and 2017, Signature HomeNow allegedly billed Medicare for home health services provided to beneficiaries who: “(i) were not homebound; (ii) did not require certain skilled care; (iii) did not have a valid or otherwise appropriate plans of care in place; and/or (iv) did not have appropriate face-to-face encounters needed in order to be appropriately certified to receive home health services,” the U.S. attorney’s office said.

1 Christi A. Grimm, Adverse Events in Hospitals: A Quarter of Medicare Patients Experienced Harm in October 2018, OEI-06-18-00400, Office of Inspector General, HHS, May 2022, https://bit.ly/3FCUi0k.
2 “2A275 - Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea: Medical Necessity and Documentation Requirements,” CMS, May 3, 2022, https://www.cms.gov/node/1611781.
3 DOJ, U.S. Attorney’s Office for the Southern District of Florida, “Home Health Company Operating in Florida Pays $2.1 Million to Resolve False Claims Allegations,” news release, May 9, 2022, https://bit.ly/3Mkwe5e.

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