News: Providers not reporting coded abuses to law enforcement, OIG audit finds

A new Office of the Inspector General (OIG) audit has revealed that approximately 20% of cases of coded abuse or neglect were not reported to law enforcement, according to JustCoding.

The OIG audited 100 cases out of 30,528 Medicare claims occurring from January 1, 2019, to December 31, 2020. The diagnostic code breakdown of the 30,528 Medicare claims was as follows:

1. Forced labor exploitation (26 cases)
2. Psychological or emotional abuse (1,668 cases)
3. Maltreatment unspecified (5,444 cases)
4. Neglect or abandonment (6,626 cases)
5. Physical abuse (7,835 cases)
6. Sexual abuse or rape (9,246 cases)

The majority of the enrollees involved in the claims were aged 60-79, and 78% were female.  

Accordingly, the OIG made four recommendations to CMS:

1. Continue to conduct analyses to identify trends and high-risk areas
2. Provide results of analyses to Quality Improvement Organizations and Medicare Program Integrity contractors
3. Develop and share guidance and best practices with providers to maintain compliance with state mandatory reporting requirements
4. Consider the results of targeted claims reviews when assessing whether the existing conditions of participation requirements for reporting abuse or neglect of Medicare enrollees should be strengthened.

Editor’s note: To read the JustCoding article, click here. To read the OIG report, click here.