Skilled nursing facilities (“SNFs”) have two new areas of focus from the Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) – infection control and tracking their use of CARES Act provider relief funds.
OIG Work Plan Update: Infection Control
Recently, the OIG updated its Work Plan, to add audit of nursing home infection prevention and control program deficiencies as a project that is underway or planned to be addressed during the fiscal year and beyond by OIG’s Office of Audit Services and Office of Evaluation and Inspections. The OIG will selectively audit SNFs to assess if their programs for infection prevention and control and emergency preparedness are in accordance with federal requirements.
The Centers for Disease Control and Prevention has indicated that individuals at high risk for severe illness from COVID-19 are people aged 65 years and older and those who live in a nursing home. As of February 2020, State Survey Agencies cited more than 6,600 nursing homes for infection prevention and control program deficiencies, including lack of a correction plan in place for these deficiencies. The OIG’s goal is to determine whether selected nursing homes have programs for infection prevention and control and emergency preparedness in accordance with federal requirements.
OIG Strategic Plan: Oversight of COVID-19
Recently, HHS announced that it would begin to deliver nearly $4.9 billion from the Public Health and Social Services Emergency Provider Relief Fund (sometimes referred to as the CARES Act Provider Relief Fund) to SNFs.
The OIG has also announced a plan to oversee COVID-19 response and recovery. The OIG’s plan contains four goals with respect to HHS’s COVID-19 response and recovery. These goals are to: (1) protect people; (2) protect funds; (3) protect infrastructure; and (4) promote the effectiveness of HHS programs.
OIG will use risk assessment and data analytics to identify, monitor and target potential fraud, waste and abuse affecting HHS programs and beneficiaries and to promote the effectiveness of HHS’s COVID-19 response and recovery programs. OIG will use technologies, including artificial intelligence, to detect trends and patterns of suspicious activity and to shape and strengthen our oversight and enforcement. As appropriate and feasible, it will share data analytics and technical assistance with HHS officials to strengthen program integrity, effectiveness and management practices. OIG will also coordinate its work with other oversight and law enforcement partners, including the Pandemic Response Accountability Committee; federal, state, local and tribal entities; and the Government Accountability Office, among others, to ensure adequate oversight, avoid duplication, and share insights.
OIG’s work will address contracts, grants, program payments and other payment mechanisms. OIG objectives include preventing, detecting and remedying waste or misspending of COVID-19 response and recovery funds by:
- Conducting audits and evaluations of HHS’s oversight, management and internal controls for awarding, disbursement and use of funds.
- Auditing fund recipients to assess whether they met use, reporting and other requirements, and, where appropriate, recommend recovery of misspent funds.
OIG also intends to combat fraud and abuse in the form of diversions of COVID-19 funding from intended purposes or exploiting emergency flexibilities granted to health and human services providers by:
- Identifying and investigating suspected fraud, in coordination with federal, state, local and tribal law enforcement partners, and exercise OIG’s administrative enforcement authorities when appropriate.
- Conducting audits and evaluations to identify program integrity vulnerabilities and recommend safeguards.
Practical Takeaways
There are several things SNFs should keep in mind as they consider these new areas of OIG focus:
- SNFs should refocus and revisit the documentation of their infection control efforts, responses and training during the COVID-19 pandemic to be ready to explain the challenges they encountered and the actions they took.
- SNFs should review and create procedures for tracking the use of the funds to demonstrate funds were not used for prohibited purposes.
If you have questions or would like additional information about this topic, please contact:
- Sean Fahey at (317) 977-1472 or sfahey@wp.hallrender.com;
- Todd Selby at (317) 977-1440 or tselby@wp.hallrender.com;
- Brian Jent at (317) 977-1402 or bjent@wp.hallrender.com; or
- Your regular Hall Render attorney.
More information about Hall Render’s Post-Acute and Long-Term Care services can be found here.
Hall Render’s attorneys and professionals continue to maintain the most up-to-date information and resources at our COVID-19 Resource page, through our 24/7 COVID‑19 Hotline at (317) 429-3900 or by contacting your regular Hall Render attorney.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot—outside of an attorney-client relationship—answer specific questions that would be legal advice.
