Targeted reviews of possible patient neglect and abuse may be on the drawing board in the wake of another report from the HHS Office of Inspector General (OIG), which found some incidents are never reported to law enforcement.^[1] OIG used diagnosis codes as breadcrumbs that led them to cases of abuse and neglect, some perpetrated by providers.

“Based on our recommendations, CMS is going to perform a trend analysis of diagnosis codes and targeted reviews,” Assistant Regional Inspector General Richard Miller told RMC. “This process will allow CMS to assess the issue and develop guidance and best practices and strengthen conditions of participation.”

OIG identified 30,258 inpatient and outpatient claims for services provided to Medicare enrollees between January 2019 and December 2020 with diagnosis codes indicating treatment for injuries possibly caused by abuse or neglect. “We included these 64 diagnosis codes because their descriptions specifically indicate potential physical abuse, sexual abuse or rape, neglect or abandonment, or other maltreatment.” Then OIG selected a stratified random sample of 100 claims and reviewed the medical records to look for evidence of potential abuse or neglect. If that was the case, OIG determined “who may have perpetrated those incidents, where they occurred, and whether law enforcement was alerted.”