CMS says it will remind providers of their responsibility to report abuse and neglect and will evaluate Conditions of Participation (CoPs) to address concerns from the latest report by the Department of Health and Human Services Office of Inspector General (OIG).
The OIG analysis sampled 100 claims that contained diagnosis codes indicating the treatment of injuries potentially caused by abuse or neglect of Medicare enrollees. Of the 100 Medicare claims sampled, 93 had medical records that contained evidence of potential abuse or neglect. Of those 93 claims, 14 were allegedly perpetrated by health care workers, 17 were related to incidents that occurred in medical facilities, and 18 were related to incidents that were not reported to law enforcement.
CMS noted in its response that Medicare- and Medicaid-certified facilities must comply with the mandatory reporting laws for abuse and neglect applicable to their state, including compliance with any timeliness requirements. “CMS will develop and share guidance to remind providers of their responsibility,” CMS noted.
CMS also said it will evaluate all available evidence as it pertains to abuse and neglect when assessing the need for revisions to the existing CoPs.
Read the full OIG report at