Statement for the Record for the United States House of Representatives 
Committee on Ways and Means 
 
 
   
Caring for Aging Americans 
 
 
  Statement for the Record 
 
Office of Inspector General  
Department of Health and Human Services 
 
 
 
 
 
November 14, 2019 
10:00 AM, 1100 Longworth House Office Building 
 
    The Office of Inspector General (OIG) for the Department of Health and Human Services (HHS) 
appreciates the opportunity provided by the U.S. House of Representatives Committee on Ways 
and Means to submit a statement for the record in connection with the Committees hearing titled 
Caring for Aging Americans.  OIGs statement for the record outlines its work involving the 
safety and health of beneficiaries in hospice care, nursing homes, skilled nursing facilities, long-
term-care hospitals, inpatient rehabilitation hospitals, and group homes.  OIG is charged with 
overseeing all HHS programs and operations.  We combat fraud, waste, and abuse; promote 
efficiency, economy, and effectiveness; safeguard taxpayer dollars, and protect the beneficiaries 
the programs serve.  To accomplish this, OIG employs tools such as data analysis, audits, 
evaluations, and investigations.  We are a multidisciplinary organization comprising 
investigators, auditors, evaluators, analysts, clinicians, and attorneys.  Over the years, we have 
developed an extensive body of work reviewing the occurrence and preventability of adverse 
events and abuse and neglect in the care facilities that are central to the well-being of many 
elderly Americans.  Our work has yielded reports and recommendations, which we discuss 
below.  
Hospice Care 
Hospice is an increasingly important benefit for the Medicare population.  And the Medicare 
hospice benefit is growingfrom 2006 to 2016, Medicare spending for hospice care increased 
81 percent to $16.7 billion, and the number of beneficiaries using the hospice benefit rose 53 
percent to over 1.4 million.  Hospice care can provide great comfort to beneficiaries, their 
families, and caregivers at the end of a beneficiarys life.  Those in hospice have the right to be 
free from abuse, neglect, and other harm.  When hospices cause harm or fail to take action when 
harm is caused by others, beneficiaries are deprived of these basic rights.  OIG is committed to 
ensuring that beneficiaries receive quality care and to safeguarding the hospice benefit.  OIG has 
completed extensive oversight work on the hospice program, including numerous evaluations 
and audits.  This work identified significant vulnerabilities in the Medicare hospice benefit and 
found that hospices sometimes failed to provide needed services to beneficiaries and sometimes 
provided poor quality care.  OIG has also conducted criminal and civil investigations of hospice 
providers, leading to the conviction of individuals, monetary penalties, and civil False Claims 
Act settlements. 
OIG released two reports which found that from 2012 through 2016, the majority of U.S. 
hospices that participated in Medicare had one or more deficiencies in the quality of care they 
provided.  Some Medicare beneficiaries were seriously harmed when hospices provided poor 
care or failed to take action in cases of abuse.   
In our report Hospice Deficiencies Pose Risks to Medicare Beneficiaries (OEI-02-17-00020), 
July 2019, we found that the most common types of deficiencies involve poor care planning, 
mismanagement of aide services, and inadequate assessments of patients.  Over 300 hospices had 
at least one serious deficiency or at least one substantiated severe complaint in 2016, which we 
considered to be poor performers.  These hospices represent 18 percent of all hospices surveyed 
nation-wide in 2016.   
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  The findings in this report provide further evidence that the Centers for Medicare & Medicaid 
Services (CMS) should implement existing OIG recommendations to strengthen the survey 
process, establish additional enforcement remedies, and empower beneficiaries and their 
caregivers to make better informed decisions about hospice care.  Specifically, CMS should: (1) 
expand the deficiency data that accrediting organizations report to CMS and use these data to 
strengthen its oversight of hospices; (2) take the steps necessary to seek statutory authority to 
include information from accrediting organizations on Hospice Compare, CMSs website that 
contains limited information about individual hospices; (3) include on Hospice Compare the 
survey reports from State agencies; (4) include on Hospice Compare the survey reports from 
accrediting organizations, once authority is obtained; (5) educate hospices about common 
deficiencies and those that pose particular risks to beneficiaries; and (6) increase oversight of 
hospices with a history of serious deficiencies.  
In our report Safeguards Must Be Strengthened to Protect Medicare Hospice Beneficiaries From 
Harm (OEI-02-17-00021), July 2019, OIG describes 12 cases of harm to hospice beneficiaries 
and identifies vulnerabilities in CMSs efforts to prevent and address harm.  These vulnerabilities 
include insufficient reporting requirements for hospices, limited reporting requirements for 
surveyors, and barriers that may impede beneficiaries and caregivers from registering 
complaints.  Also, these hospices did not face serious consequences for the harm described in 
this report.  Specifically, surveyors did not always cite immediate jeopardy in cases of significant 
beneficiary harm, and hospices plans of correction are not designed to address underlying 
issues.  In addition, CMS cannot impose penalties, other than termination, to hold hospices 
accountable for harming beneficiaries. 
CMS must address these vulnerabilities.  To effectively protect beneficiaries from harm, CMS 
needs enforcement tools, as we have recommended in the past.  CMS must also strengthen 
safeguards to protect Medicare hospice beneficiaries from harm.  Specifically, CMS should (1) 
strengthen requirements for hospices to report abuse, neglect, and other harm; (2) ensure that 
hospices educate their staff to recognize signs of abuse, neglect, and other harm; (3) strengthen 
guidance for surveyors to report crimes to local law enforcement; (4) monitor surveyors use of 
immediate jeopardy; and (5) improve and make user-friendly the process for beneficiaries and 
caregivers to make complaints. 
Nursing Homes, Skilled Nursing Facilities, Long-Term-Care Hospitals, Inpatient 
Rehabilitation Hospitals, and Group Homes 
High-quality nursing homes can deliver enormous benefit as places of comfort and healing.  For 
Medicare beneficiaries, nursing homes provide a clinically managed recovery period after illness 
and injury that can make the difference between more good years ahead or a downward spiral.  
For long-term-care residents and their families, often insured through Medicaid, nursing homes 
can provide responsible and much-needed care to those in fragile health. 
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  Many nursing homes provide excellent care and diligently protect their residents.  But an 
alarming number of residents are subject to costly medical harm, unsafe conditions, and abuse 
and neglect, much of it preventable with better practices and oversight.  Nursing home care is a 
critical component of the continuum of care.  Quality and safety of care in nursing homes affect 
the provision and cost of care in other settings.  With an aging population and heightened focus 
on value-driven care, it is increasingly critical that Federal and State funds are used to purchase 
safe, high-quality care for vulnerable elderly and disabled patients.  
CMS and States share responsibility for ensuring that nursing homes meet Federal requirements 
for quality and safety.  CMS requires State agencies to conduct a survey (inspection) of 
nursing homes at least every 15 months to certify each facilitys compliance.  CMS oversees the 
State certification process and provides guidance regarding the survey process in its State 
Operations Manual and Interpretive Guidelines.  When State Agencies identify deficiencies 
during their surveys, nursing homes must submit correction plans, and State Agencies must 
verify that the facility corrected its deficiencies.  CMS and State Medicaid agencies may also 
take enforcement actions to address nursing home deficiencies, including imposing civil 
monetary penalties or terminating the nursing home from the Medicare program.   
Most nursing homes are certified to serve as both long-term-care facilities and skilled nursing 
facilities (SNFs).  SNFs render skilled nursing care and, in most cases, skilled rehabilitative 
services and other related healthcare services to help patients recover from injury, disability, or 
illness, typically following a hospital stay.  Skilled nursing care is given or supervised by 
registered nurses.  Examples of skilled nursing care include administering intravenous drugs, 
injections, or tube feedings; changing dressings; and disease-management education.  Skilled 
rehabilitative services include physical therapy, occupational therapy, and speech therapy.  
Medicare does not consider skilled services to include any service that could be performed safely 
by a nonmedical person without the supervision of a nurse.  Approximately 1.4 million Medicare 
beneficiaries received care in SNFs in 2016.  Federal expenditures on nursing home care exceed 
$70 billion annually, including in 2017 $43 billion for Medicaid long-term care and $28 billion 
for Medicare post-acute and other skilled care.   
OIG found, in our report Adverse Events in Skilled Nursing Facilities: National Incidence 
Among Medicare Beneficiaries (OEI-06-11-00370), February 2014, that one in three SNF 
patients experienced adverse events during their nursing home stays, including infections, 
pressure ulcers, and misuse of medication.  In a nation-wide review, OIG found that one-third of 
patients in SNFs experienced harm from the care provided in the nursing homes and more than 
half of the harm (adverse events) were preventable if the facilities had provided better care.  This 
report was one in a decade-long OIG series regarding adverse events in various healthcare 
settings, including hospitals.  The adverse events OIG identified in nursing homes resulted in a 
range of harmful outcomes for beneficiaries, including extended stays in the SNF, transfers to 
hospital emergency departments, and the need for life-sustaining intervention.  For 6 percent of 
the adverse events, the harm contributed to residents death.  Over half of the patients who 
experienced harm returned to a hospital for treatment, incurring millions of dollars in additional 
Medicare expenditures.  OIGs work in this realm also includes our report Adverse Events in 
Hospitals: National Incidence Among Medicare Beneficiaries (OEI-06-09-00090), November 
2010, and will continue with our upcoming Work Plan item Adverse Events in Hospitals: 
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  National Incidence Among Medicare Beneficiaries10-Year Update, OEI-06-18-00400, 
estimated in late 2020.   
Some adverse events involved medical errors such as supplying incorrect medication, but most 
preventable harm resulted from daily substandard care, such as inadequate resident monitoring 
and failure or delay of necessary care.  For these adverse events, patients and families often 
attribute bad outcomes to the underlying disease process without realizing that failures of care 
caused or contributed to the harm..  Nursing home staff also failed to identify harm in some 
cases; for example, a number of adverse events started with dehydration, which can quickly 
result in kidney damage.  One nursing home resident died of cardiac arrest after progressive 
kidney failure that was not detected until the resident was awaiting discharge from the SNF. 
A shift in thinking about the care provided in nursing homes is needed.  Our adverse events work 
shows that nursing home residents often had care needs similar to patients in hospitals, with 
residents sometimes seriously ill and impaired.  The hospital community has focused keenly on 
patient safety and, while still experiencing high harm rates in some categories, has made 
substantial changes in the provision of patient care and safety systems.  Sustained improvements 
in nursing homes will require a cultural shift that recognizes clinical harm and elevates reduction 
of harm as a priority for nursing home care. 
The foundation of OIGs recommendations to reduce harm is that CMS (and the Agency for 
Healthcare Research and Quality) raise awareness of adverse events in nursing homes (and other 
post-acute-care settings) with the same methods used to promote hospital safety.  Broadening 
these and other patient safety improvement efforts to include the nursing home environment 
would ensure that safe care practices promoted in acute care hospitals extend to the critical 
periods of post-acute recovery and long-term care.  To address the high rate of harm in nursing 
homes, OIG made two recommendations to CMS: (1) provide guidance to nursing homes about 
detecting and reducing harm to be included in facility Quality Assurance and Performance 
Improvement programs, and (2) instruct State agencies to review facility practices for identifying 
and reducing adverse events, and link related deficiencies specifically to resident safety 
practices.  OIG determined that CMS fully implemented these recommendations on adverse 
events in SNFs as of August 2018.  It is too early to assess the effectiveness of CMSs actions in 
changing practices, but they hold promise for improving quality of care and reducing adverse 
events for nursing home residents.  
OIG has also studied patient safety in long-term-care hospitals (LTCHs) and inpatient 
rehabilitation hospitals.  LTCHs are inpatient hospitals that provide long-term care to clinically 
complex patients, such as those with multiple acute or chronic conditions.  Medicare 
beneficiaries typically enter LTCHs following an acute-care hospital stay to receive intensive 
rehabilitation and medical care. LTCHs are the third most common type of post-acute-care 
facility after SNFs and inpatient rehabilitation hospitals.  In our report Adverse Events in Long-
Term-Care Hospitals: National Incidence Among Medicare Beneficiaries (OEI-06-14-00530), 
November 2018, OIG found that 21 percent of Medicare patients in LTCHs experienced adverse 
events, which are particularly serious instances of patient harm resulting from medical care.  The 
four categories of adverse events include outcomes such as prolonging a patients LTCH stay or 
necessitating transfer to another facility; requiring life-saving intervention; resulting in 
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  permanent harm; and contributing to death.  Five percent of Medicare patients in LTCHs 
experienced adverse events that contributed to or resulted in their deaths.  An additional 25 
percent of patients experienced temporary harm events, which are patient harm that required 
medical intervention but did not cause lasting harm.  The overall percentage of patients in 
LTCHs who experienced either type of harm (adverse events or temporary harm events) is 46 
percent, higher than OIG found in hospitals (27 percent), skilled nursing facilities (33 percent), 
and rehabilitation hospitals (29 percent).  Patient stays in LTCHs present more opportunities for 
harm events because the stays are longer, but the number of harm events per patient day was 
similar between LTCHs and other post-acute-care settings and lower than in non-LTCH acute-
care hospitals.  Over half of these adverse events and temporary harm events (54 percent of harm 
events) were clearly or likely preventable.  Preventable harm events were often related to 
substandard care (58 percent) and medical errors (34 percent).  Forty-five percent of harm events 
were found to be clearly or likely not preventable, often because the patients were highly 
susceptible to harm due to other health conditions or poor overall health. 
OIG has also examined adverse events in rehabilitation (rehab) hospitals.  Rehab hospitals are 
post-acute providers that specialize in intensive rehabilitative care for patients recovering from 
illness, injury, or surgery.  In our report Adverse Events in Rehabilitation Hospitals: National 
Incidence Among Medicare Beneficiaries, (OEI-06-14-00110), July 2016, OIG found that an 
estimated 29 percent of Medicare beneficiaries experienced adverse or temporary harm events 
during their rehab hospital stays, resulting in temporary harm; prolonged stays or transfers to 
other hospitals; permanent harm; life-sustaining intervention; or death.  This harm rate is in line 
with what we found in hospitals (27 percent) and in SNFs (33 percent).  Physician reviewers 
determined that 46 percent of these adverse and temporary harm events were clearly or likely 
preventable.  Physicians attributed much of the preventable harm to substandard treatment, 
inadequate patient monitoring, and failure to provide needed treatment.  Nearly one-quarter of 
the patients who experienced adverse or temporary harm events were transferred to an acute-care 
hospital for treatment, with an estimated cost to Medicare of at least $7.7 million in 1 month, or 
at least $92 million in 1 year, assuming a constant rate of hospitalization throughout the year. 
Concerns about unreported abuse and neglect in nursing homes persist.  For example, in our 
report Incidents of Potential Abuse and Neglect at Skilled Nursing Facilities Were Not Always 
Reported and Investigated (A-01-16-00509), June 2019, OIG assessed the prevalence and 
reporting of incidents of potential abuse or neglect of Medicare beneficiaries residing in SNFs 
who had a hospital emergency room Medicare claim in calendar year 2016.  We determined that 
one in five of these high-risk claims may have resulted from abuse or neglect.  A SNF must 
ensure that all incidents involving alleged abuse and neglect are reported immediately to the 
administrator of the facility and to the survey agency.  We determined that SNFs failed to report 
an estimated 6,608 instances of potential abuse or neglect (as identified in high-risk hospital 
emergency room Medicare claims) to the survey agencies in 2016.  Because of this failure to 
report, survey agencies could not review, prioritize, or conduct immediate onsite investigations, 
if necessary, to determine whether abuse, neglect, or other violations had occurred.  Lastly, we 
determined that CMS does not require all incidents of potential abuse or neglect and related 
referrals made to law enforcement to be recorded and tracked in their complaint and incident 
tracking system.  We recommended that CMS take action to ensure that incidents of potential 
abuse or neglect of Medicare beneficiaries residing in SNFs are identified and reported by 
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  working with the survey agencies to improve training for staff of SNFs on how to identify and 
report incidents of potential abuse or neglect of Medicare beneficiaries; clarifying guidance to 
define and provide examples of incidents of potential abuse or neglect; requiring the survey 
agencies to record and track all incidents of potential abuse or neglect in SNFs and referrals 
made to local law enforcement and other agencies; and monitoring the survey agencies 
reporting of findings of substantiated abuse to local law enforcement. 
Medicare claims can be used to identify incidents of potential abuse or neglect, regardless of 
where the beneficiary resides.  As shown in our report CMS Could Use Medicare Data to 
Identify Instances of Potential Abuse or Neglect (A-01-17-00513), June 2019, many incidents of 
potential abuse or neglect were not reported to law enforcement as required.  Medicare claims 
data identified more than 30,000 incidents of potential abuse or neglect.  In our review, we 
identified Medicare claims in all States that contained diagnosis codes indicating the treatment of 
injuries potentially caused by abuse or neglect of Medicare beneficiaries from January 1, 2015, 
through June 30, 2017.  All of the diagnosis codes were assigned by the health professional who 
treated the Medicare beneficiaries.  Most of the actual incidents that caused harm occurred in 
settings other than medical facilities.  Only 10 percent were associated with incidents where the 
injuries occurred in a medical facility, such as a nursing home.  Healthcare workers were the 
likely perpetrators of incidents of potential abuse or neglect in about 7 percent of the claims.    
Approximately 90 percent of the medical records identified by this analysis contained evidence 
of potential abuse or neglect.  This evidence included, but was not limited to, witness statements 
and photographs.  We estimated that 30,754 claims were supported by medical records that 
contained evidence of potential abuse or neglect.  Despite laws in every State requiring 
healthcare professionals to report suspected abuse or neglect or exploitation of vulnerable adults, 
providers frequently failed to alert appropriate authorities.  Approximately 27 percent of claims 
were not reported to law enforcement by mandatory reporters. 
Section 1150B of the Act and the Federal Conditions of Participation (CoPs) contained in CFR 
Title 42 for long-term-care facilities, such as nursing homes and SNFs, include reporting 
requirements for incidents of suspected abuse or neglect.  For these facilities, covered individuals 
must report any reasonable suspicion of a crime, such as certain instances of abuse, neglect, or 
exploitation.  The CoPs for hospitals require that hospitals follow State laws for mandatory 
reporting.  Group homes and assisted-living facilities are covered by State regulations regarding 
the reporting of potential abuse or neglect, and their employees are generally covered by State 
laws for mandatory reporting. 
OIGs work on critical incident reporting at group homes showed that group home providers 
failed to report many critical incidents to the appropriate State agencies.1  These critical incidents 
                                                           
1 OIG, Connecticut Did Not Comply With Federal and State Requirements for Critical Incidents Involving 
Developmentally Disabled Medicaid Beneficiaries (A-01-14-00002), May 2016; OIG, Massachusetts Did 
Not Comply With Federal and State Requirements for Critical Incidents Involving Developmentally 
Disabled Medicaid Beneficiaries (A-01-14-00008), July 2016; OIG, Maine Did Not Comply With Federal 
and State Requirements for Critical Incidents Involving Medicaid Beneficiaries With Developmental 
Disabilities (A-01-16-00001), August 2017; Alaska Did Not Fully Comply With Federal and State 
 
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  included death, physical/sexual assault, serious injuries, and missing persons.    OIG believes that 
improved data collection and analysis can improve patient safety and quality of care.   
OIG released A Resource Guide for Using Diagnosis Codes in Health Insurance Claims To 
Help Identify Unreported Abuse or Neglect, (guide) in July 2019 to provide assistance with data 
collection.  The guide instructs how to use claims data to identify incidents of potential abuse or 
neglect of vulnerable populations.  The guide synthesizes the methodologies that OIG developed 
in our extensive work on identifying unreported critical incidents, particularly those involving 
potential abuse or neglect.  The guide includes a flow chart showing key decision points in the 
process and the detailed lessons that OIG has learned using this approach.  We encourage CMS, 
States, providers and other public and private sector entities to use this guide to develop a 
process tailored to their specific circumstances and apply it to any vulnerable population they 
deem appropriate.  The sources of data could include Medicaid Management Information System 
claims data, private payor insurance claims data, or similar data sets.  Analyzing the data can 
help identify individual incidents of unreported abuse or neglect, and patterns and trends of 
abuse or neglect involving specific providers, beneficiaries, or patients who may require 
immediate intervention to protect their health, safety, and rights.  The guide also provides 
technical information, such as examples of medical diagnosis codes, to assist CMS, States, 
providers and others with analyzing claims data to help combat abuse and neglect. 
Further, a listing of significant unimplemented OIG recommendations related to abuse and 
neglect, as well as CMSs response to those recommendations, can be found in our report 
Solutions to Reduce Fraud, Waste, and Abuse in HHS Programs: Top Recommendations, July 
2019.  Some of these recommendations include (1) CMS should compile a list of diagnosis codes 
that indicate potential abuse or neglect, conduct periodic data extracts, and inform States that the 
data are available to help the States ensure compliance with their mandatory reporting laws; (2) 
CMS should take action (e.g., provide training, clarify guidance) to ensure that incidents of 
potential abuse or neglect of Medicare beneficiaries residing in SNFs are identified and reported; 
(3) CMS should assess the sufficiency of existing Federal requirements to report suspected abuse 
and neglect of Medicare beneficiaries, regardless of where services are provided, and strengthen 
those requirements or seek additional legislative authorities if appropriate; and (4) CMS should 
improve its guidance to State Agencies on verifying nursing homes correction of deficiencies 
and maintaining documentation to support verification. 
Correction of Deficiencies at Nursing Homes 
State survey agencies perform surveys to determine whether nursing homes meet the Federal 
CoPs.  From 2015 to 2018, OIG completed audits of nine States and issued a consolidated report 
(CMS Guidance to State Survey Agencies on Verifying Correction of Deficiencies Needs To Be 
Improved To Help Ensure the Health and Safety of Nursing Home Residents (A-09-18-02000), 
February 2019) to CMS regarding whether the survey agency took appropriate steps to verify 
that nursing facilities had corrected identified deficiencies.  We found that seven States failed to 
verify or maintain sufficient evidence that they had verified nursing homes correction of 
deficiencies as required by Federal rules.  Specifically, for 47 percent of the sampled deficiencies 
                                                           
Requirements for Reporting and Monitoring Critical Incidents Involving Medicaid Beneficiaries With 
Developmental Disabilities (A-09-17-020016), June 2019. 
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  (326 of the 700), these survey agencies did not obtain or maintain evidence of nursing homes 
correction of deficiencies.  If survey agencies certify that nursing homes are in substantial 
compliance without properly verifying the correction of deficiencies and maintaining sufficient 
documentation to support the verification of deficiency correction, the health and safety of 
nursing home residents may be at risk. 
In addition, OIG issued a data brief (Trends in Deficiencies at Nursing Homes Show That 
Improvements Are Needed to Ensure the Health and Safety of Residents (A-09-18-02010), April 
2019) that analyzed nursing home deficiencies identified by State survey agencies across the 
nation.  Overall, we found that the number of deficiencies slightly increased from CYs 2013 
through 2016, then slightly decreased in CY 2017.  Also, the overall average number of 
deficiencies identified by standard and complaint surveys slightly increased from CYs 2013 
through 2017, which would suggest that survey agencies identified more deficiencies per survey 
in CY 2017 than they did in CY 2013.  However, approximately 31 percent of nursing homes 
had a repeat deficiency (i.e., a deficiency type that was cited at least five times in separate 
surveys).  Further, at least half of these nursing homes experienced an incident of a more serious 
deficiency, including incidents of substandard quality of care, actual harm, and immediate 
jeopardy to residents.  The results of our data analysis raise questions as to whether the quality of 
care and services provided to nursing home residents improved during our review period. 
Ongoing Work 
OIG has ongoing work on quality of nursing home care. For example, OIG has two ongoing 
reports about staffing at nursing homes as reported by the Payroll-Based Journal (PBJ), an 
auditable database of payroll information that each nursing home must submit to CMS each 
quarter.  CMS uses the PBJ to populate the staffing component of the Nursing Home Compare 
website and analyze staffing patterns.  The first report will describe nurse staffing levels as 
reported in the PBJ, and the second report will examine CMSs efforts to ensure the accuracy of 
PBJ data and use the data to help improve resident quality of care.     
Additional ongoing work reexamines the extent to which State survey agencies met required 
timeframes for investigating the most serious nursing home complaints, after finding that some 
States fell short between 2011 and 2015.  In October 2019, OIG released an updated Trends in 
Nursing Home Complaints online interactive map with nursing home complaint data from 2016 
through 2018.  A forthcoming report will offer insights on those States that previously fell short 
in timely investigation of the most serious nursing home complaints and other trends that raise 
questions. 
Finally, OIG also has ongoing work related to facility-initiated discharges from nursing homes.  
The forthcoming reports will describe the extent to which State long-term care ombudsmen 
address facility-initiated discharges and the extent to which State survey agencies investigated 
and took enforcement actions against nursing homes for inappropriate facility-initiated 
discharges.  This work will also determine the extent to which nursing homes meet CMS 
requirements for facility-initiated discharges. 
 
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  Conclusion 
OIG continues to prioritize overseeing the care for aging Americans and protecting the safety 
and health of beneficiaries in hospice care, nursing homes, skilled nursing facilities, long-term-
care hospitals, inpatient rehabilitation hospitals, and group homes, and we are committed to 
helping to reduce adverse events and prevent abuse and neglect in these facilities.  We will 
continue to leverage our analytic, investigative, and oversight tools, as well as our partnerships 
with the program integrity community, the Department, and Congress to ensure these vulnerable 
populations are better served.  Thank you for affording OIG this opportunity to highlight our 
important work, and please do not hesitate to contact us with any further questions. 
 
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