OIG Audits Expose Vulnerabilities in HHS Programs

The U.S. Department of Health and Human Services Office of Inspector General (OIG) plays a crucial role in safeguarding the integrity of HHS programs. Its recent Fall 2024 Semiannual Report to Congress highlights several areas where improvements are needed to protect vulnerable populations, ensure access to essential healthcare, and optimize resource utilization.

Protecting Vulnerable Populations

• Nursing Home Safety: A significant number of for-profit nursing homes were found to be non-compliant with federal requirements for infection preventionists, potentially jeopardizing the health and safety of residents.
• Child Welfare Oversight: Many states lack comprehensive data to effectively monitor residential facilities for children in foster care, hindering efforts to identify and prevent abuse and neglect.

Ensuring Access to Essential Healthcare

• Maternal Health: States are not consistently leveraging provider coverage requirements and network adequacy standards to ensure access to a full range of maternal health services in Medicaid managed care.
• Medicare Coverage and Payment: Medicare was found to have improperly paid hospitals for mechanical ventilation services and significant cost disparities were identified for beneficiaries receiving Stelara under different coverage scenarios.

Why This Matters to Healthcare Companies

The OIG's findings in its 2024 Semiannual Report to Congress highlight areas of concern within HHS programs that are likely to be the focus of increased scrutiny in 2025. By identifying vulnerabilities in nursing home safety, child welfare oversight, maternal health access, and Medicare coverage and payment, the OIG has signaled its intent to delve deeper into these areas. Healthcare companies should proactively assess their compliance with relevant regulations and standards to mitigate potential risks and prepare for potential OIG investigations.