OIG’s Solutions to Reduce Fraud, Waste, and Abuse in HHS Programs

Angie SzumlinskiAnnouncements

Last July the Office of Inspector General released it’s annual report Solutions to Reduce Fraud, Waste and Abuse in HHS Programs: OIG’s Top Recommendations. In it, the top 25 unimplemented recommendations are identified along with the 25 recommendations from 2018 that were put in place.

CMS has not implemented the recommendations from the OIG yet, but they have published a fact sheet for consumers and providers that details the importance of understanding the 3-day rule. It does not indicate that they are reviewing the requirement or altering their current practices; however, it does explain who is financially responsible if an admission to a SNF does not meet the requirement.

An interesting change/clarification is “If there is no 3-day qualifying hospital inpatient stay (that is, the 3-day rule for SNF coverage is not met), Medicare does not require the SNF to issue a SNF Advance Beneficiary Notice of Non-coverage (SNF ABN) in order to charge the beneficiary for non-covered care. However, we strongly encourage SNFs to do so, because the SNF does not expect Medicare payment and the patient (and/or the patient’s representative) should fully understand the patient’s liability for the cost of the stay.” As providers we need to be doing the right thing for the right reasons. There are not many seniors who are financially able to cover a SNF stay (on a private pay basis). Be sure to review referrals thoughtfully and be an advocate for our seniors.