Recently, in an article posted by the Office of Inspector General (OIG), scenarios are presented that illustrate a lack of quality-of-care for patients in senior nursing facilities. The article more specifically addresses how skilled nursing facilities, nursing homes that provide 24-hour assistance with day-to-day activities and rehabilitation services for patients, may not be the proper outlet for Medicare to be investing 32 billion dollars--as they did in 2012.
According to the OIG, the illegal use and dispensing of prescription drugs is at epidemic proportions. The OIG will continue to aggressively use data analysis through its partnerships to shut down the Medicare fraud occurring through drug diversion.
According to an OIG Report (http://oig.hhs.gov/oei/reports/oei-07-09-00440.asp), inaccuracies were found in Medicare enrollment databases that CMS is charged with oversight and collection of data. In order to enroll in Medicare, providers must supply their NPIs and other information to CMS to be entered into the Provider Enrollment, Chain and Ownership System (PECOS). Accurate, complete, and consistent provider data in NPPES and PECOS help to ensure the integrity of all health care programs. Previous OIG review has revealed ongoing problems with CMS's oversight of provider data, sometimes resulting in improper Medicare payments to fraudulently enrolled providers.
The special focus status is meant to push Nursing Homes to fix underlying problems found in inspections, or face exclusion from Medicare and Medicaid programs. Nursing homes put on the Special Focus Facility list receive increased attention and inspections.