CMS can do more to leverage Medicare claims data to identify unreported incidents of potential abuse or neglect

CMS can do more to leverage Medicare claims data to identify unreported incidents of potential abuse or neglect

Collection:
Health Policy and Services Research
Contributor(s):
United States. Department of Health and Human Services. Office of Inspector General. Office of Audit Services, issuing body.
Publication:
[Washington, D.C.] : U.S. Department of Health and Human Services, Office of Inspector General, November 2023
Language(s):
English
Format:
Text
Subject(s):
Child Abuse -- legislation & jurisprudence
Elder Abuse -- legislation & jurisprudence
Government Regulation
Medicare -- statistics & numerical data
Vulnerable Populations -- legislation & jurisprudence
United States
Centers for Medicare & Medicaid Services (U.S.)
Genre(s):
Technical Report
Abstract:
Why OIG Did This Audit. We previously conducted an audit of CMS’s use of Medicare data to identify incidents of potential abuse or neglect and found that CMS did not use Medicare claims data to identify incidents of abuse or neglect of Medicare enrollees. CMS did not concur with three of our four prior audit recommendations. Our objectives were to determine: (1) the prevalence of incidents of potential abuse or neglect of Medicare enrollees for 2019 and 2020, (2) who may have perpetrated those incidents and where they occurred, and (3) whether the incidents were reported to law enforcement. How OIG Did This Audit. Our audit covered claims from January 2019 through December 2020 for services provided to treat Medicare enrollees with diagnosis codes related to abuse or neglect. We sampled 100 Medicare claims and reviewed the medical records to determine whether they contained evidence of potential abuse or neglect, who perpetrated those incidents, where they occurred, and whether law enforcement was alerted. We also discussed with CMS the reasons for its nonconcurrence with our prior recommendations.
Copyright:
The National Library of Medicine believes this item to be in the public domain. (More information)
Extent:
1 online resource (1 PDF file (33 pages))
Illustrations:
Illustrations
NLM Unique ID:
9918750686806676 (See catalog record)
Permanent Link:
http://resource.nlm.nih.gov/9918750686806676