Department of Health and Human Services 

OFFICE OF 

INSPECTOR GENERAL 

HOME HEALTH AGENCIES 

RECEIVED TIMELY SURVEYS 

AND CORRECTED 

DEFICIENCIES AS REQUIRED 

Daniel R. Levinson 

Inspector General 

April 2013 

OEI-06-11-00400 
 

EXECUTIVE SUMMARY: HOME HEALTH AGENCIES RECEIVED TIMELY SURVEYS AND 

CORRECTED DEFICIENCIES AS REQUIRED 

OEI-06-11-00400 

WHY WE DID THIS STUDY 

Over the last decade, the use of home health services increased significantly and Medicare payments to home 

health agencies (HHA) more than doubled. To ensure that HHAs comply with Federal requirements, the 

Centers for Medicare & Medicaid Services (CMS) contracts with each State survey agency (State agency) 

and three accreditation organizations to conduct initial certification surveys of HHAs, recertification surveys, 

and complaint investigations. CMS also monitors the performance of accreditation organizations by 

contracting with State agencies to perform “look-behind” surveys of HHAs recently surveyed by 

accreditation organizations. CMS compares an accreditation organization’s survey of an individual HHA 

with a State agency’s subsequent survey of the same HHA, and then uses that information in aggregate to 

evaluate the accreditation organization’s overall survey performance. A 2008 study by the Office of 

Inspector General (OIG) found that many HHAs had the same deficiencies cited during multiple 

recertification surveys and CMS rarely used the only sanction available—termination—to address HHA 

noncompliance. 

HOW WE DID THIS STUDY 

Using CMS data for Federal fiscal years 2010 and 2011, we identified the extent to which State agencies and 

accreditation organizations conducted timely recertification surveys of HHAs. We also identified the extent 

to which HHAs received deficiency citations, corrected deficiencies, or had complaints lodged against them. 

Additionally, we determined the extent to which CMS used 

look-behind surveys to assess the performance of accreditation organizations and State agencies. 

WHAT WE FOUND 

State agencies and accreditation organizations conducted recertification surveys for nearly all HHAs within 

the required 36-month timeframe and cited 12 percent of HHAs with “condition”-level deficiencies, the most 

serious type of deficiency. Ninety-three percent of these HHAs corrected their condition-level deficiencies 

within the required 90-day timeframe; the remaining 7 percent corrected the deficiencies late or left 

Medicare. Fifteen percent of HHAs had complaints lodged against them; surveyors conducted complaint 

investigation surveys for nearly all of these HHAs and cited 7 percent of them with condition-level 

deficiencies. With few exceptions, HHAs corrected all condition-level deficiencies cited during complaint 

surveys. State agencies exceeded the required number of look-behind surveys for oversight of accreditation 

organizations. CMS rarely conducted look-behind surveys for oversight of State agencies’ surveys of HHAs; 

such look-behind surveys are not required by Federal regulation. 

WHAT WE RECOMMEND 

We recommend that CMS analyze survey data to determine whether it should routinely conduct 

look-behind surveys for oversight of State agencies, which conduct most HHA recertification surveys. 

CMS concurred with our recommendation and stated that its central office will work with the CMS regional 

offices to identify State agencies with the greatest need for look-behind surveys. 
TABLE OF CONTENTS 

Objectives ....................................................................................................1 

Background..................................................................................................1 

Methodology................................................................................................7 

Findings......................................................................................................10 

Surveyors conducted recertification surveys on time for 

98 percent of HHAs and cited 12 percent of HHAs with 

condition-level (i.e., serious) deficiencies .....................................10 

Among the HHAs with condition-level deficiencies, 93 percent 

corrected all deficiencies within required timeframes ...................12 

Surveyors conducted complaint surveys for virtually all of the 

15 percent of HHAs that had complaints lodged against them ......12 

State agencies conducted look-behind surveys of 14 percent 

of HHAs surveyed by accreditation organizations, exceeding 

CMS’s 5-percent standard ..............................................................14 

CMS rarely conducted look-behind surveys for oversight of 

State agencies’ surveys of HHAs; such look-behind surveys 

are not required by Federal regulation ...........................................15 

Conclusion and Recommendation .............................................................16 

Agency Comments and Office of Inspector General Response .....17 

Appendixes ................................................................................................18 

A: The Number and Percentage of Home Health Agencies 

with Condition-Level Deficiency Citations on Recertification 

Surveys During Fiscal Years 2010–11 ...........................................18 

B: Types of Substantiated Complaints Lodged Against Home
 

Health Agencies During Fiscal Years 2010–11 ..............................21 

C: Agency Comments ...................................................................22 

Acknowledgments......................................................................................23 
 

 

 

OBJECTIVES 

1.	 To determine the extent to which State survey agencies (State 

agencies) and accreditation organizations conducted recertification 

surveys of home health agencies (HHA) within required timeframes 

during fiscal years (FY) 2010–11.1 

2.	 To determine the extent to which HHAs received deficiency citations 

on recertification surveys and the nature and resulting actions of those 

deficiencies during FYs 2010–11. 

3.	 To determine the extent to which HHAs had complaints lodged 

(i.e., allegations made) against them, the nature of those complaints, 

and the actions resulting from those complaints during FYs 2010–11. 

4.	 To determine the extent to which the Centers for Medicare & Medicaid 

Services (CMS) used “look-behind” surveys to assess the performance 

of surveyors during FYs 2010–11. 

BACKGROUND 

HHAs provide home health services for Medicare beneficiaries with 

short- or long-term illnesses or injuries who are confined to their homes 

and need skilled nursing care on an intermittent basis, physical therapy, 

speech therapy and/or continuing occupational therapy.2 In recent years, 

the use of Medicare home health services has grown. From 2002 to 2010, 

Medicare beneficiaries receiving home health services increased by nearly 

35 percent (from 2.6 to 3.4 million beneficiaries), and the number of 

Medicare-certified HHAs increased by 69 percent (from 6,813 to 

11,548 HHAs).3, 4 In 2010, Medicare paid $19.5 billion for home health 

services, compared to $9.6 billion in 2002. 

Survey and Certification of Home Health Agencies 

All HHAs participating in the Medicare program must comply with 

15 Medicare Conditions of Participation (CoP).5 

 The CoPs fall into 

two areas: administration and furnishing of services. Twelve of the 

1

 All fiscal year references in this report are based on the Federal fiscal year (October 1 

through September 30).
 2 Social Security Act, §§ 1812(a)(3), 1814(a)(2)(C), 1832(a)(2)(A), 1835(a)(2)(A), and 

1861(m). 

3

 CMS, Data Compendium, 2003, 2011. Accessed at https://www.cms.gov on May 23, 

2012. From 2002 to 2010, the number of Medicare beneficiary visits conducted by
 

HHAs increased by 60 percent (from 78.1 million visits to 124.7 million visits).
 4

 CMS, Financial Report, 2011, p. 138. 5

 Social Security Act §§ 1861(o)(6) and 1891(a); 42 CFR pt. 484 (subparts B and C). 

Home Health Agencies Received Timely Surveys and Corrected Deficiencies As Required (OEI-06-11-00400) 1 
 

 

 

 

 

 

 

 

 

fifteen CoPs are subdivided into “standards,” which address specific 

aspects of the CoPs.6 

To ensure compliance with the 15 CoPs, CMS enters into agreements with 

State agencies and accreditation organizations to conduct initial 

certification surveys of HHAs, recertification surveys, and complaint 

investigations.7 In this report, we use the term “surveyors” to refer to both 

State agencies and accreditation organizations. 

Recertification Surveys. Federal law requires that HHAs receive a 

recertification survey at least every 36 months to verify compliance with 

the CoPs.8 Recertification surveys review “the quality of care and services 

furnished by the agency as measured by indicators of medical, nursing, 

and rehabilitative care,” and include patient home visits and interviews 

with patients and HHA staff.9 Recertification surveys also include a 

review of previous survey data (if available), complaint data, and clinical 

records.10 

Deficiency Citations. If a surveyor determines that an HHA is out of 

compliance with a standard during a recertification survey, the surveyor 

can cite the HHA with a “standard-level deficiency.” If the surveyor 

determines that the HHA is out of compliance with a CoP, the surveyor 

can cite the HHA with a “condition-level deficiency,” the more serious 

type of deficiency.11 

Correcting Deficiencies. If an HHA has one or more condition-level 

deficiencies, it is considered out of compliance with the CoPs. For such 

noncompliance, the surveyor must provide the HHA with a Statement of 

6

 The three CoPs that are not defined further by standards are: release of patient 

identifiable Outcome and Assessment Information Set (OASIS) information (42 CFR 

§ 484.11); qualifying to furnish outpatient physical therapy or speech pathology services 

(42 CFR § 484.34); and medical social services (42 CFR § 484.38). 

7

 Social Security Act, §§ 1891(c)(2)(A) and 1865(a); 42 CFR § 488.10(d). The three 

accreditation organizations approved to conduct surveys are the Accreditation 

Commission for Health Care, the Community Health Accreditation Program, and the 

Joint Commission. 

8

 Social Security Act, § 1891(c)(2)(A); CMS, pt. I, section II.E, Recertification Surveys, 

of the Advance Copy of App. B to CMS, State Operations Manual, Pub. No. 100-07 

(SOM, Advance App. B), attached to CMS Memorandum to State Survey Agency 

Directors, S&C 11-11-HHA, February 11, 2011 (effective May 1, 2011). For HHA 

recertification surveys, CMS includes 90 percent of the succeeding month to permit 

completion of any survey in progress. See CMS, Division of Survey and Certification, 

Quality Assurance for the Medicare & Medicaid Programs, FY 2011 Mission & Priority 

Document, September 3, 2010 (revised October 15, 2010). 9

 Social Security Act, § 1891(c)(2)(C)(i)(II); CMS, SOM, Advance App. B, pt. I, 

section II.B, Standard Survey.
 10 CMS, SOM, Advance App. B, pt. I, section II.E, Recertification Surveys, and pt. I,
 

section III, Task 1, Pre-Survey Preparation. 

11 CMS, SOM, Advance App. B, pt. I, section III, Task 4, Information Analysis. 

Home Health Agencies Received Timely Surveys and Corrected Deficiencies As Required (OEI-06-11-00400) 2 
 

 

 

  

 

Deficiencies and Plan of Correction form that includes evidence to support 

the deficiency citation(s) and a section that HHAs can use to document a 

plan of correction. The HHA must respond with a plan of correction 

within 10 calendar days of receiving this form.12 If an HHA with 

standard-level deficiencies submits an acceptable plan of correction for 

achieving compliance within a reasonable period of time, which is 

generally no longer than 60 days after notification of the deficiencies, the 

surveyor will certify the HHA as in compliance with the CoPs.13 

For an HHA with one or more condition-level deficiencies, a surveyor 

cannot certify compliance based solely on a plan of correction. In these 

cases, CMS must place the HHA on a 90-day termination track (the only 

enforcement remedy currently available to CMS).14, 15 To continue 

participating in Medicare, the HHA must submit a “credible allegation of 

compliance,” and achieve compliance or acceptable progress within the 

90-day timeframe.16 If a surveyor documents “immediate jeopardy” to 

patient health and safety, the State agency must place the HHA on a 

23-day termination track, using the same procedures as the 90-day 

termination track.17 

Complaint Investigations. Medicare beneficiaries, families of 

beneficiaries, HHA staff, physicians, and others can lodge complaints 

against HHAs to a variety of entities, including State agencies, 

accreditation organizations, and CMS. CMS and State agencies track 

complaints lodged, categorize them into different severity levels, and 

determine actions to take (e.g., referral to another agency, offsite 

12 CMS, SOM, Pub. No. 100-07, ch. 2, §§ 2728, 2728A, and 2728B. 13 Ibid. An acceptable plan of correction must include the following elements: plan of 

correcting the specific deficiency and addressing the processes that led to the deficiency 

cited; procedure for implementing the acceptable plan of correction for the specific 

deficiency cited; monitoring procedure to ensure that the plan of correction is effective 

and that specific deficiency cited remains corrected and/or in compliance with the 

regulatory requirements; and title of the person responsible for implementing the 

acceptable plan of correction. 

14 CMS, SOM, ch. 3, § 3012. 15 On November 8, 2012, CMS issued a final rule to implement intermediate (or 

alternative) sanctions for noncompliant HHAs. For more information on this rule, see the 

“Other Studies” section on page 6. 

16 CMS, SOM, ch. 3, § 3016A. “Credible allegation of compliance” is defined as “a 

statement or documentation: that is realistic in terms of the possibility of corrective 

action being accomplished between the exit conference and the date of allegation; and 

that indicates resolution of the problems.” 

17 CMS, SOM, ch. 3, § 3010B. 

Home Health Agencies Received Timely Surveys and Corrected Deficiencies As Required (OEI-06-11-00400) 3 
 

 

 

 

 

 

 

investigation, onsite investigation) on the basis of those severity levels.18 

CMS and State agencies categorize lodged complaints into one of eight 

severity levels, and CMS requires surveyors to conduct complaint 

investigation surveys (hereafter referred to as complaint surveys) for the 

three most severe of these: 

	 Immediate jeopardy: Provider’s noncompliance with the CoPs has 

caused or is likely to cause serious injury, harm, impairment, or 

death.19 

	 Non-immediate jeopardy high: Provider’s noncompliance with the 

CoPs may have caused harm that negatively affects the 

individual’s mental, physical, and/or psychosocial status and is of 

such consequence to the person’s well-being that a rapid response 

by the State agency is indicated.20 

	 Non-immediate jeopardy medium: Provider’s noncompliance with 

the CoPs caused or may cause harm that is of limited consequence 

and does not significantly impair the individual’s mental, physical, 

and/or psychosocial status or function.21 

Surveyors conducting complaint surveys focus on the specific regulatory 

requirements related to the complaint lodged. If surveyors identify 

significant problems, the surveyors can expand the survey to review the 

HHA’s compliance with other CoPs.22 If surveyors find evidence 

supporting the complaint, the surveyors substantiate the complaint.23 

During a complaint survey, surveyors not only determine whether the 

complaint is substantiated, but also cite any deficiencies found, which may 

or may not directly relate to the complaint. If surveyors find 

condition-level deficiencies, they can place the HHA on a termination 

track. To continue participating in Medicare, the HHA must submit an 

18 CMS, SOM, ch. 5, §§ 5075.1–5075.8. CMS and State agencies categorize lodged
 

complaints into one of the following eight severity levels: immediate jeopardy, 

non-immediate jeopardy high, non-immediate jeopardy medium, non-immediate jeopardy
 

low, administrative review/offsite investigation, immediate referral, other referral, and no
 

action necessary. 

19 CMS, SOM, ch. 5, § 5075.1, p. 14. 20 CMS, SOM, ch. 5, § 5075.2, p. 15. Although the SOM states that only nursing home 

complaints—as opposed to complaints regarding other facilities—can be categorized at 

the level “non-immediate jeopardy high,” a CMS official explained that some complaints
 

lodged against HHAs are also categorized at this level and require complaint surveys 

within 2 or 10 days.
 21 CMS, SOM, ch. 5, § 5075.3, p. 16. 22 CMS, SOM, ch. 5, § 5200.1, p. 33. 23 CMS, SOM, ch. 9, Exhibit 23.
 

Home Health Agencies Received Timely Surveys and Corrected Deficiencies As Required (OEI-06-11-00400) 4 
 

 

 

 

acceptable plan of correction, as it does when deficiencies are cited during 

a recertification survey.24 

For the other five levels of complaints lodged, the surveyor can wait until 

the next survey to review the issue related to the complaint.25 

Additionally, surveyors can refer the complaint to another agency or entity 

(e.g., law enforcement or licensure agency) for investigation or for 

informational purposes.26 

“Look-Behind” Surveys of Accreditation Organizations and 

State Agencies 

Federal law requires that CMS annually report to Congress about the 

performance of accreditation organizations.27 To assess these 

organizations’ performance, CMS enters into agreements with State 

agencies for the agencies to annually conduct “look-behind” surveys of a 

representative sample of at least 5 percent of HHAs surveyed by 

accreditation organizations.28 These surveys (which CMS refers to as 

“validation surveys”) enable CMS to compare an accreditation 

organization’s results for an individual HHA with those from a State 

agency’s subsequent survey of the same HHA. 

The look-behind survey, which a State agency must conduct no later than 

60 days following an accreditation organization’s survey of the same 

HHA, reviews the HHA’s compliance with the CoPs. During a 

look-behind survey, the State agency can cite the HHA with deficiencies in 

the same way as during a certification or recertification survey. Once the 

State agency completes the survey, it provides CMS with the survey 

results. For each HHA that receives a look-behind survey, CMS compares 

the condition-level deficiencies identified by the State agency to those 

identified by the accreditation organization.29 CMS uses this information 

in aggregate to calculate a disparity rate, which is the percentage of all 

look-behind surveys in which the accreditation organization missed a 

condition-level deficiency identified by a State agency.30 

24 CMS, SOM, ch. 5, § 5200.1, p. 33. 25 CMS, SOM, ch. 5, §§ 5075.4, 5075.5, and 5075.8. 26 CMS, SOM, ch. 5, §§ 5075.6–5075.7. 27 Social Security Act, § 1875(b). 

28 CMS, Division of Survey and Certification, Quality Assurance for the Medicare &
 

Medicaid Programs, FY 2011 Mission & Priority Document, September 3, 2010 (revised 

October 15, 2010). 

29 CMS, Financial Report, 2010, p. 152. 30 Ibid., p. 154. The disparity rate is calculated by taking the number of look-behind 

surveys in which a State agency found at least one condition-level deficiency that a given 

accreditation organization had missed for the same HHA, and dividing it by the total 

number of look-behind surveys for that accreditation organization. 

Home Health Agencies Received Timely Surveys and Corrected Deficiencies As Required (OEI-06-11-00400) 5 
 

 

 

 

 

Federal law does not require CMS to conduct look-behind surveys to 

assess State agencies’ performance in surveying HHAs, but CMS may 

conduct such surveys if it wishes. In these cases, CMS itself conducts the 

look-behind survey of an HHA, rather than contracting with another entity 

to do it. CMS then compares its results for an individual HHA with the 

State agency’s results for the same HHA. Although look-behind surveys 

to evaluate State agencies’ performance (surveys that CMS refers to as 

“Federal monitoring surveys”) are not required vis-à-vis State agencies’ 

surveys of HHAs, they are required for State agencies’ surveys of nursing 

homes, which serve beneficiary populations similar to those of HHAs, and 

CMS routinely conducts such surveys.31 

Other Studies 

A 2008 report by the Office of Inspector General (OIG) found that many 

HHAs had the same deficiencies cited during multiple recertification 

surveys.32 Further, the study found that CMS rarely used the only sanction 

available—termination—to address HHAs with repeated deficiencies. In 

the report, OIG recommended that CMS implement intermediate sanctions 

for HHAs as required by the Omnibus Budget Reconciliation Act of 

1987.33 In March 2012, OIG reiterated this recommendation in an early 

alert memorandum to CMS that outlined CMS’s limited action toward 

promulgating regulations for the HHA intermediate sanctions.34 In 

November 2012, CMS issued a final rule to implement intermediate (or 

alternative) sanctions for noncompliant HHAs. The first set of sanctions, 

which will become effective on July 1, 2013, includes temporary 

management, directed plans of correction, and directed in-service training. 

Two additional sanctions—civil money penalties and suspension of 

Medicare payments for new patient admissions—will become effective on 

July 1, 2014.35 

31 Social Security Act, §§ 1819(g)(3)(B)(Medicare) and 1919(g)(3)(B)(Medicaid); CMS, 

SOM, ch. 4, § 4157D. Federal law requires CMS to conduct look-behind surveys of at 

least 5 percent of the number of nursing homes surveyed by each State agency each year, 

but in no case is CMS to survey fewer than five nursing homes in each State per year. 32 Department of Health and Human Services (DHHS), OIG, Deficiency History and 

Recertification of Medicare Home Health Agencies, OEI-09-06-00040, August 2008. 33 Omnibus Budget Reconciliation Act of 1987, P.L. 100-203, § 4023 (adding Social 

Security Act, §§ 1891(e) and (f)). 

34 DHHS, OIG, Early Alert Memorandum Report: Intermediate Sanctions for 

Noncompliant Home Health Agencies, OEI-06-11-00401, March 2012. 35 77 Fed. Reg. 67068 (November 8, 2012). 

Home Health Agencies Received Timely Surveys and Corrected Deficiencies As Required (OEI-06-11-00400) 6 
 

METHODOLOGY 

Scope 

This evaluation examines all Medicare-certified HHAs that received a 

recertification survey, had a complaint lodged against them, and/or 

received a look-behind survey during FYs 2010–11. Consequently, this 

evaluation does not include HHAs that did not receive a recertification 

survey during FYs 2010–11. 

Data Collection and Analysis 

To analyze all HHA recertification surveys and complaints during 

FYs 2010–11, we obtained data from three CMS databases: the 

Automated Survey Processing Environments (ASPEN), the Certification 

and Survey Provider Enhanced Reporting (CASPER), and the Accrediting 

Organization System for Storing User Recorded Experiences (ASSURE). 

ASPEN and CASPER store data from recertification surveys conducted by 

State agencies and include all HHA enrollment, termination, and 

complaint data. ASSURE stores data from HHA recertification surveys 

conducted by accreditation organizations. To analyze look-behind 

surveys, we obtained copies of Statement of Deficiencies forms from 

CMS. 

Recertification Surveys. We identified all HHAs that received a 

recertification survey during FYs 2010–11, using data from ASPEN and 

CASPER for surveys conducted by State agencies and ASSURE for 

surveys conducted by accreditation organizations.36 To identify and 

calculate the percentage of HHAs that received a recertification survey 

within the required timeframe, we counted the number of working days 

since the prior recertification survey date.37 For each recertification 

survey, we identified all deficiency citations and calculated the percentage 

of HHAs with citations. We focused additional analysis on citations for 

condition-level deficiencies, the more serious of the two kinds of 

deficiencies. We identified whether HHAs corrected their condition-level 

deficiencies, returned to compliance within the required 90-day timeframe, 

or were terminated from Medicare. For each scenario, we calculated the 

associated percentage of HHAs. 

36 This analysis included only recertification surveys, not other types of surveys such as 

initial certification surveys. 

37 We used 36.9 months as our criteria for calculating surveys conducted within the 

required timeframe because CMS includes 90 percent of the succeeding month to permit 

completion of any survey in progress. See CMS, Division of Survey and Certification,
 

Quality Assurance for the Medicare & Medicaid Programs, FY 2011 Mission & Priority 

Document, September 3, 2010 (revised November 15, 2010). 

Home Health Agencies Received Timely Surveys and Corrected Deficiencies As Required (OEI-06-11-00400) 7 
 

Complaints and Complaint Surveys. We used ASPEN to identify all 

HHAs that had a complaint lodged against them alleging noncompliance 

during FYs 2010–11.38 We calculated the percentage of HHAs with any 

complaints lodged and identified the severity of those complaints. We 

also calculated the percentage of HHAs with substantiated complaints and 

the percentage of HHAs that received a complaint survey. Although 

ASPEN indicated that HHAs received a complaint survey, ASPEN did not 

contain records of the survey results for all HHAs. More specifically, it 

was missing one or more survey records for 261 HHAs that received a 

complaint survey.39 As a result, our analysis of complaint surveys 

included only HHAs for which ASPEN had survey records.40 For each 

complaint survey, we identified all deficiency citations and calculated the 

percentage of HHAs with such citations. We focused additional analysis 

on citations for condition-level deficiencies and identified whether HHAs 

corrected these deficiencies, returned to compliance within the required 

90-day timeframe, or were terminated from Medicare. 

Look-Behind Surveys. We identified all HHAs that received a look-behind 

survey during FYs 2010–11 using Statement of Deficiencies forms 

obtained from CMS. For State agencies, we identified whether surveyors 

each year collectively conducted look-behind surveys of 5 percent of 

HHAs surveyed by accreditation organizations, as required by CMS. For 

each look-behind survey, we identified condition-level deficiencies cited 

by State agencies but missed by accreditation organizations. Using this 

information, we calculated a disparity rate across the three accreditation 

organizations. Lastly, we identified the extent to which CMS voluntarily 

conducted look-behind surveys of State agency-surveyed HHAs to assess 

State agencies’ performance. 

Limitations 

This study has two limitations. First, we did not compare deficiency 

citation rates between HHAs surveyed by State agencies and those 

surveyed by accreditation organizations because the surveying entities 

conduct recertification surveys differently—though all State agencies use 

similar survey instruments and methodology, each accreditation 

organization uses its own process. Moreover, although accreditation 

organizations must match their deficiency citations to those used by State 

38 In our analysis, we did not include any complaints unrelated to the Federal 

requirements, such as complaints related solely to State matters, which were outside the 

scope of the study. 

39 A CMS official indicated that a failure of the complaint survey records to upload into 

ASPEN may likely be the cause of the missing records.
 40 This analysis includes only complaint surveys, not other types of surveys such as initial 

certification surveys. 

Home Health Agencies Received Timely Surveys and Corrected Deficiencies As Required (OEI-06-11-00400) 8 
 

 

agencies, a deficiency cited by an accreditation organization may not 

correspond directly to a deficiency cited by a State agency. Second, we 

could not include all HHAs that received a complaint survey in our 

analysis because ASPEN was missing one or more complaint survey 

records for 261 HHAs. 

Standards 

This study was conducted in accordance with the Quality Standards for 

Inspection and Evaluation issued by the Council of the Inspectors General 

on Integrity and Efficiency. 

Home Health Agencies Received Timely Surveys and Corrected Deficiencies As Required (OEI-06-11-00400) 9 
 

 

FINDINGS 

Surveyors conducted recertification surveys on time 

for 98 percent of HHAs and cited 12 percent of HHAs

with condition-level (i.e., serious) deficiencies 

Surveyors conducted recertification surveys of 6,316 HHAs during 

FYs 2010–11. Eighty-two percent of these HHAs (5,210) were surveyed 

by State agencies, whereas 18 percent (1,106) were surveyed by 

accreditation organizations. Ninety-eight percent of these 6,316 HHAs 

(6,190) received a recertification survey within the required 36-month 

timeframe. For the remaining 2 percent of HHAs (126), surveyors were 

late in conducting the survey by a median of 3.3 months. Of the 

126 HHAs that were surveyed late, 32 HHAs were not surveyed until 

more than a year after the required 36-month timeframe. 

Collectively, surveyors cited 12 percent of HHAs with at least 

one condition-level deficiency, but citation varied widely by 

State agency and by accreditation organization 

Among the 6,316 HHAs that received a recertification survey, surveyors 

cited deficiencies—including both standard-level and condition-level 

deficiencies—for 74 percent (4,694). For the remaining 26 percent of 

HHAs (1,622), surveyors cited no deficiencies. Among the 74 percent of 

HHAs with deficiencies, surveyors cited 62 percent (3,942 of 6,316) with 

standard-level deficiencies only, and cited an additional 12 percent (752 of 

6,316) with at least one condition-level deficiency, the more serious type 

of deficiency (see Figure 1). 

Figure 1: HHAs With Deficiency Citations on Recertification Surveys 

Source: OIG analysis of 6,316 HHAs’ recertification surveys in FYs 2010–11. 

Home Health Agencies Received Timely Surveys and Corrected Deficiencies As Required (OEI-06-11-00400) 10 
 

 

Home Health Agencies Received Timely Surveys and Corrected Deficiencies As Required (OEI-06-11-00400) 11 

 

Among the HHAs with condition-level deficiencies, surveyors found 

noncompliance across all 15 CoPs and cited a total of 

1,736 condition-level deficiencies. Fifty-four percent of these HHAs 

(409 of 752) received two or more condition-level deficiency citations.41 

The HHA with the most condition-level deficiencies was cited for 13 of 

the 15 CoPs. 

The most frequently cited condition-level deficiency among these HHAs, 

cited for 35 percent of HHAs (265 of 752), involved noncompliance with 

“acceptance of patients, plan of care, and medical supervision.” (Table 1 

lists the number and percentage of HHAs with condition-level deficiencies 

in each of the 15 CoPs.) 

Table 1: HHAs Cited With Condition-Level Deficiencies, by Condition of 

Participation 

Condition of Participation* 

HHAs Cited With 

Condition-Level 

Deficiency 

(n=752) 

Percentage 

Acceptance of patients, plan of care and medical 

supervision 265 35% 

Organization, services and administration 241 32% 

Skilled nursing services 200 27% 

Clinical records 183 24% 

Evaluation of the agency’s program 157 21% 

Comprehensive assessment of patients 145 19% 

Reporting OASIS information 145 19% 

Group of professional personnel 130 17% 

Home health aide services 129 17% 

Patient rights 42 6% 

Therapy services 42 6% 

Compliance with Federal, State, and local laws 30 4% 

Medical social services 21 3% 

Release of patient personally identifiable information 5 <1% 

Outpatient physical therapy or speech pathology services 1 <1% 

Note: Some HHAs had more than one recertification survey and could have received a condition-level deficiency
 

citation for the same CoP more than once; however, we counted each HHA only once for each CoP. 

*See 42 CFR pt. 484 (subparts B and C). 

Source: OIG analysis of 752 HHAs cited with condition-level deficiencies on recertification surveys in 

FYs 2010–11. 

Surveyors varied in the percentages of HHAs they cited with 

condition-level deficiencies during recertification surveys. State agencies 

gave condition-level deficiency citations to between 0 and 50 percent of 

the HHAs they surveyed. Despite conducting recertification surveys for 

41 Surveyors cited 343 HHAs with 1 condition-level deficiency, 164 HHAs with 2, 

107 HHAs with 3, and 138 HHAs with 4 or more condition-level deficiencies. 
 

Home Health Agencies Received Timely Surveys and Corrected Deficiencies As Required (OEI-06-11-00400) 12 

multiple HHAs, nine State agencies did not cite any condition-level 

deficiencies, whereas eight State agencies cited condition-level 

deficiencies for 20 percent or more of the HHAs receiving recertification 

surveys. (See Appendix A-1 for the number and percentage of HHAs that 

were cited for condition-level deficiencies, by State.) Accreditation 

organizations gave condition-level deficiency citations to between 8 and 

33 percent of the HHAs they surveyed. (See Appendix A-2 for the number 

and percentage of HHAs with condition-level deficiencies, by 

accreditation organization.) 

Among the HHAs with condition-level deficiencies, 

93 percent corrected all deficiencies within required

timeframes 

Surveyors placed nearly all HHAs with condition-level deficiencies 

(741 of 752) on a 90-day termination track. Ninety-three percent of HHAs 

(692 of 741) with condition-level deficiencies corrected all deficiencies 

and returned to compliance within the required 90-day timeframe. These 

HHAs returned to compliance an average of 38 days following the 

recertification survey. 

The remaining 7 percent of HHAs (49 of 741) did not return to 

compliance within the 90-day timeframe. Among these 49 HHAs, 

33 corrected their deficiencies shortly after the 90-day timeframe, 

returning to compliance an average of 130 days following the 

recertification survey. However, one HHA did not return to compliance 

until more than a year after the recertification survey. A CMS official 

explained that HHAs likely exceeded the timeframe because surveyors did 

not conduct timely followup visits or provide the HHAs with a statement 

of deficiencies, typically resulting in an extension of the termination date. 

Another 16 of the 49 HHAs never corrected their condition-level 

deficiencies; CMS terminated the Medicare participation for 8 of these 

HHAs, and 3 HHAs voluntarily discontinued their participation. The 

remaining five HHAs continued participation in Medicare, yet CMS could 

not determine whether the HHAs corrected their deficiencies. 

Surveyors conducted complaint surveys for virtually

all of the 15 percent of HHAs that had complaints 

lodged against them 

CMS received 5,888 complaints concerning 1,784 HHAs (15 percent of all 

HHAs) in FYs 2010–11. CMS classified the complaints42 lodged against 

42 In this report, the term “complaint” means (unless specified otherwise) a complaint that 

has been lodged—i.e., an allegation. 
 

Home Health Agencies Received Timely Surveys and Corrected Deficiencies As Required (OEI-06-11-00400) 13 

 

 

 

 

7 percent of HHAs (126 of 1,784) as immediate jeopardy, the most severe 

level of complaint. The most common severity level of complaints lodged 

was non-immediate jeopardy medium, accounting for 78 percent of all 

HHAs (1,387) with complaints lodged against them. (Table 2 lists the 

number and percentage of HHAs with complaints lodged against them, 

categorized by severity level.) 

Table 2: Complaints Lodged Against HHAs, by Severity Level 

Severity Level of Complaints Lodged 

(Most Severe to Least Severe) 

HHAs With Complaints 

Lodged Against Them 

(n=842) 

Percentage 

Immediate jeopardy 126 7% 

Non-immediate jeopardy high 143 8% 

Non-immediate jeopardy medium 1,387 78% 

Non-immediate jeopardy low 239 13% 

Non-immediate jeopardy administrative 

review/offsite investigation 108 6% 

Referral—immediately 3 <1% 

Referral—other 8 <1% 

No action necessary 1 <1% 

Note: Some HHAs had more than one complaint lodged against them; however, we counted each HHA only
 

once for each complaint severity level. 

Source: OIG analysis of 1,784 HHAs with complaints lodged against them in FYs 2010–11. 

Surveyors conducted complaint surveys for 1,781 of the 1,784 HHAs that 

had one or more complaints lodged against them. For the remaining 

three HHAs, surveyors neither conducted nor required a complaint survey. 

Surveyors found supporting evidence and substantiated at least 

one complaint for 47 percent of HHAs (842 of 1,784) with complaints 

lodged against them. Two or more complaints were substantiated for 

nearly 70 percent of these HHAs (586 of 842).43 For one HHA alone, 

surveyors substantiated 25 complaints. The most common type of 

complaint, substantiated for 523 HHAs, related to quality of care and 

treatment of patients. (Table 3 lists the most common types of complaints 

lodged and substantiated against HHAs and Appendix B provides a 

comprehensive list of lodged and substantiated complaints.) 

Of the 1,615 HHAs with complaint survey records stored in ASPEN, 

7 percent (113 of 1,615) were cited with at least one condition-level 

deficiency.44 Surveyors cited an additional 39 percent of HHAs 

43 Two hundred fifty-six HHAs had one substantiated complaint, 196 HHAs had 2, 

164 HHAs had 3, 87 HHAs had 4, and 139 HHAs had 5 or more substantiated 

complaints. 

44 As previously stated, we could not include in this analysis the 261 HHAs that received 

a complaint survey but lacked records of the survey results in ASPEN. 
 

(636) with standard-level deficiencies only. For the remaining 54 percent 

of HHAs (866), surveyors cited no deficiencies. 

Table 3: HHAs With Substantiated Complaints, by Complaint Type 

Description of Complaint 

HHAs With Complaints 

Lodged Against Them 

(n=1,784) 

HHAs With 

Substantiated 

Complaints (n=842) 

Quality of care/treatment 1,089 523 

Administration/personnel 665 312 

Patient rights 622 250 

Nursing services 370 156 

Admission, transfer, and discharge rights 286 124 

Falsification of records/reports 207 88 

Fraud/false billing 175 72 

Patient neglect 167 77 

Note: Some HHAs had more than one complaint lodged against them and/or more than one substantiated
 

complaint; however, we counted each HHA only once for each complaint description.
 

Source: OIG analysis of 1,784 HHAs with complaints lodged against them in FYs 2010–11. 

With few exceptions, HHAs corrected all condition-level 

deficiencies cited during complaint surveys 

Surveyors placed all HHAs that were cited for a condition-level deficiency 

during a complaint survey on a 90-day termination track. 

Eighty-two percent of HHAs (93 of 113) that were cited for 

condition-level deficiencies corrected all deficiencies and returned to 

compliance within required timeframes—on average, 32 days following 

the complaint survey. Among the 18 percent of HHAs (20 of 113) that did 

not return to compliance as required, CMS terminated the Medicare 

participation of 9 HHAs, and another 4 HHAs voluntarily discontinued 

their participation. The remaining seven HHAs corrected their 

condition-level deficiencies after the required 90-day timeframe, returning 

to compliance, on average, 120 days following the complaint survey. 

State agencies conducted look-behind surveys of 

14 percent of HHAs surveyed by accreditation 

organizations, exceeding CMS’s 5-percent standard 

Accreditation organizations conducted recertification surveys of 

18 percent of all HHAs (1,106 of 6,316) during FYs 2010–11. To monitor 

accreditation organizations’ performance during this time, State agencies 

conducted look-behind surveys of 14 percent (153) of the 1,106 HHAs 

surveyed by the three accreditation organizations. This exceeded CMS’s 

5-percent standard for look-behind surveys of HHAs surveyed by 

accreditation organizations. For 24 of the 153 HHAs that received a 

look-behind survey, State agencies identified condition-level deficiencies 

Home Health Agencies Received Timely Surveys and Corrected Deficiencies As Required (OEI-06-11-00400) 14 
 

that accreditation organizations missed, resulting in an overall 16-percent 

disparity rate. 

CMS rarely conducted look-behind surveys for 

oversight of State agencies’ surveys of HHAs; such 

look-behind surveys are not required by Federal 

regulation 

Although State agencies conduct most recertification surveys (82 percent 

of all HHAs during FYs 2010–11), Federal regulations do not require 

CMS to perform look-behind surveys to assess State agencies’ survey 

performance. Further, during FYs 2010–11, CMS rarely conducted such 

surveys. Specifically, among the 5,210 HHAs that received recertification 

surveys from State agencies, 5 HHAs—about one-tenth of 1 percent— 

received a look-behind survey from CMS, with all 5 surveys occurring in 

FY 2010. The small number of look-behind surveys prevents any 

conclusion as to the usefulness of conducting such surveys. It also 

prevents CMS from calculating disparity rates for State agencies’ surveys 

of HHAs and thus from using these rates to evaluate State agencies in the 

manner it evaluates accreditation organizations. 

Home Health Agencies Received Timely Surveys and Corrected Deficiencies As Required (OEI-06-11-00400) 15 
 

 

CONCLUSION AND RECOMMENDATION 

Over the last decade, the use of home health services increased 

significantly and Medicare payments for such services and the number of 

HHAs both more than doubled. CMS is responsible for ensuring that 

HHAs comply with Federal requirements and provide quality care, and 

CMS relies on State agencies and accreditation organizations to verify 

HHAs’ compliance through onsite surveys and complaint investigations. 

Overall, we found that surveyors conducted recertification surveys and 

investigated complaints as required and that HHAs cited with 

condition-level deficiencies took corrective action during FYs 2010–11. 

To assess accreditation organizations’ survey performance, CMS 

contracted with State agencies to conduct look-behind surveys of HHAs 

surveyed by accreditation organizations. However, CMS is not required to 

conduct, and rarely conducted, similar look-behind surveys to assess State 

agency survey performance. Given that State agencies conducted the vast 

majority of HHAs’ recertification surveys (82 percent in FYs 2010–11) 

and demonstrated wide variation in citing condition-level deficiencies, the 

lack of look-behind surveys for oversight of State agencies could present a 

vulnerability to program effectiveness and quality of care for Medicare 

beneficiaries. By way of comparison, CMS is required to conduct, and 

routinely conducts, look-behind surveys of State agency-surveyed nursing 

homes, which serve beneficiary populations similar to those of HHAs. 

We recommend that CMS: 

Analyze Survey Data to Determine Whether It Should Routinely 

Conduct Look-Behind Surveys for Oversight of State Agencies 

CMS should analyze existing survey data to determine whether to assess 

State agency survey performance and implement routine look-behind 

surveys of HHAs surveyed by State agencies. Conducting look-behind 

surveys for State agencies in the same manner as those that CMS is 

required to conduct for accreditation organizations would provide CMS 

with disparity rates for State agencies. Considering that many State 

agencies cited few or no condition-level deficiencies for HHAs during 

recertification surveys, look-behind surveys would also provide CMS with 

insight regarding variation among States in issuing condition-level 

deficiency citations. 

Home Health Agencies Received Timely Surveys and Corrected Deficiencies As Required (OEI-06-11-00400) 16 
 

 

AGENCY COMMENTS AND OFFICE OF INSPECTOR GENERAL 

RESPONSE 

CMS concurred with our recommendation to analyze survey data to 

determine whether it should routinely conduct look-behind surveys for 

oversight of State agencies. CMS stated that its central office will work 

with the CMS regional offices to identify State agencies with the greatest 

need for look-behind surveys. CMS also stated that it will evaluate other 

oversight options to monitor State agency performance. For the full text 

of CMS’s comments, see Appendix C. 

Home Health Agencies Received Timely Surveys and Corrected Deficiencies As Required (OEI-06-11-00400) 17 
 

 

 

 

APPENDIX A 

The Number and Percentage of Home Health Agencies Cited 

With Condition-Level Deficiencies on Recertification Surveys 

During Fiscal Years 2010–11 

Table A-1: Home Health Agencies Cited With Condition-Level Deficiencies 

on Recertification Surveys Conducted by State Survey Agencies During 

Fiscal Years 2010–11 

State 

Home Health Agencies 

(HHA) Receiving a 

Recertification Survey 

(n=5,210) 

HHAs Cited With 

Condition-Level 

Deficiencies (n=542) 

Percentage of HHAs 

Cited With 

Condition-Level 

Deficiencies 

U.S. Virgin Islands 2 1 50% 

Michigan 64 31 48% 

Idaho 27 9 33% 

Montana 24 8 33% 

Colorado 86 25 29% 

Nevada 35 8 23% 

California 375 74 20% 

Maine 5 1 20% 

Kansas 98 15 15% 

Puerto Rico 20 3 15% 

Arizona 51 7 14% 

Ohio 308 42 14% 

Vermont 7 1 14% 

Indiana 135 17 13% 

New Mexico 39 5 13% 

Alabama 65 8 12% 

Florida 351 37 11% 

Iowa 99 11 11% 

Texas 1,114 123 11% 

Connecticut 50 5 10% 

District of Columbia 20 2 10% 

New Hampshire 20 2 10% 

Minnesota 131 12 9% 

continued on next page 

Home Health Agencies Received Timely Surveys and Corrected Deficiencies As Required (OEI-06-11-00400) 18 
 

 

Table A-1: Home Health Agencies Cited With Condition-Level Deficiencies 

on Recertification Surveys Conducted by State Survey Agencies During 

Fiscal Years 2010–11 (Continued) 

State 

Home Health Agencies 

(HHA) Receiving a 

Recertification Survey 

(n=5,210) 

HHAs Cited With 

Condition-Level 

Deficiencies (n=542) 

Percentage of HHAs 

Cited With 

Condition-Level 

Deficiencies 

New Jersey 22 2 9% 

Utah 64 6 9% 

Arkansas 119 9 8% 

Kentucky 73 6 8% 

Illinois 287 21 7% 

Louisiana 105 7 7% 

Massachusetts 86 6 7% 

Georgia 64 4 6% 

Missouri 119 7 6% 

Wyoming 16 1 6% 

Oklahoma 108 5 5% 

Washington 22 1 5% 

New York 115 5 4% 

Tennessee 48 2 4% 

West Virginia 53 2 4% 

South Dakota 37 1 3% 

Virginia 104 3 3% 

South Carolina 48 1 2% 

Wisconsin 86 2 2% 

North Carolina 108 1 1% 

Pennsylvania 228 3 1% 

Alaska 11 0 0% 

Delaware 11 0 0% 

Hawaii 7 0 0% 

Maryland 18 0 0% 

Mississippi 26 0 0% 

Nebraska 52 0 0% 

North Dakota 14 0 0% 

Oregon 29 0 0% 

Rhode Island 4 0 0% 

Source: Office of Inspector General (OIG) analysis of Automated Survey Processing Environments’ recertification data for
 

fiscal years 2010–11. 

Home Health Agencies Received Timely Surveys and Corrected Deficiencies As Required (OEI-06-11-00400) 19 
 

 

Table A-2: Home Health Agencies Cited With Condition-Level Deficiencies 

on Recertification Surveys Conducted by Accreditation Organizations 

During Fiscal Years 2010–11 

Accreditation 

Organization 

Home Health Agencies 

(HHA) Receiving a 

Recertification Survey 

(n=1,106) 

HHAs Cited With 

Condition-Level 

Deficiencies (n=210) 

Percentage of HHAs 

Cited With 

Condition-Level 

Deficiencies 

The Joint Commission 480 159 33% 

Accreditation Commission 

for Health Care 142 13 9% 

Community Health 

Accreditation Program 484 38 8% 

Note: Each accreditation organization uses its own survey instrument and methodology. Although accreditation organizations must 

match their deficiency citations to those used by State agencies, a deficiency cited by an accreditation organization may or may not 

correspond directly to a deficiency cited by a State agency. 

Source: OIG analysis of recertification data from the Accrediting Organization System for Storing User Recorded Experiences for fiscal 

years 2010–11. 

Home Health Agencies Received Timely Surveys and Corrected Deficiencies As Required (OEI-06-11-00400) 20 
 

 

APPENDIX B 

Types of Complaints Lodged and Substantiated Against Home 

Health Agencies During Fiscal Years 2010–11 

Complaint Description 

Home Health Agencies (HHA) 

With Complaints Lodged 

Against Them (n=1,784) 

HHAs With Substantiated 

Complaints (n=842) 

Quality of care/treatment 1,089 523 

Administration/personnel 665 312 

Patient rights 622 250 

Nursing services 370 156 

Admission, transfer, and discharge rights 286 124 

Other 228 111 

Falsification of records/reports 207 88 

Patient neglect 167 77 

Fraud/false billing 175 72 

Unqualified personnel 136 71 

Patient assessment 94 50 

Patient abuse 97 42 

Misappropriation of property 100 38 

Infection control 57 26 

Rehabilitation services 41 19 

Physician services 28 15 

Other services 32 11 

State licensure 7 4 

Accidents 8 3 

Quality of life 8 2 

Physical environment 10 2 

Pharmaceutical services 6 1 

Death 5 1 

Educational services 3 1 

State monitoring 2 1 

Restraints/seclusion—general 1 1 

No classification given 8 0 

Injury of unknown origin 5 0 

Note: Some complaints had more than one description and some HHAs had more than one complaint; however, we counted each
 

HHA only once for each complaint description.
 

Source: Office of Inspector General analysis of complaints data from Automated Survey Processing Environments for fiscal
 

years 2010-11. 

Home Health Agencies Received Timely Surveys and Corrected Deficiencies As Required (OEI-06-11-00400) 21 
...•~...--.•.

(;T DEPARTMENT OF HEALTH & HUMAN SERVICES

..••.

.(a-'-oI"#III

Cen.ers lor Medicare & Medicaid Services

AdminislTator

Washlng.on. DC 2020'

DATE: MAR 0 5 2013

TO: Daniel R. Levinson

Inspector General

FROM: Marilyn TlN.enner

Acting ~dminislrator

SUBJECT: Office of Inspector General (OIG) Draft Report: Home Health Agencies Received Timely

Surveys and Corrected Deficiencies as Required (OEI-06-11-00400)

Thank you for the opportunity to review and comment on the above subject draft report .. The Centers

for Medicare & Medicaid Services (eMS) appreciates the extensive work done by OIG staff in the

development of the report. eM is dedicated to its responsibility to oversee the surveys of home health

agencies (HHAs) on a timely basis and making sure all deficiencies are corrected in order to protect the

beneficiaries served by these providers. urveys of HHAs are conducted by both state agencies and

approved Accrediting Organizations (AOs). Surveys include initial certifications, recertification and

complaint surveys as well as validation surveys of AOs. eMS recognizes the growth of HHAs and the

risks posed to the Medicare program and the importance of compliance with eMS requirements. The

OIG s objectives for this study are to determine the extent to which: (1) state survey agencies and

accreditation organizations conducted recertification surveys of HHAs within required timeframes

during fiscal years (FYs) 2010-11; (2) HHAs received deficiency citations on recertification surveys

and the nature and resulting actions of those deficiencies during FYs 2010-11; (3) HHAs had

complaints lodged (i.e., allegations made) against them, the nature of those complaints, and the

actions resulting from those complaints during FYs 2010-11; and (4) eMS used "look-behind"

surveys to assess the performance of surveyors during FYs 2010-11.

The OIG recommendation and eMS response are discussed below.

OIG Recommendation

The OIG recommends that eMS analyze survey data to determine whether it should routinely

conduct look-behind surveys for oversight of state agencies.

CMS Response

The eMS concurs with this recommendation. eMS is striving to strengthen our reviews of HHAs in

a variety of ways. An increase in HHA look-behind survey activity would be an effective tool in this

effort. While look-behind activity in HHAs is not statutorily based, eMS's central office will work

with our regional offices to develop criteria that will target the need for HHA look behind activity in

a particular state agency based upon the agency's survey reports, to the extent possible within

existi.ng fiscal constraints. CMS will also evaluate a variety of other options to assure effective lookbehind oversight of SA performance.

The eMS looks forward to working with OIG on this and other issues in the future.

APPENDIX C 

Agency Comments 

 

Survey and Certification of Home Health Agencies in FY 2010-2011 (OEI-06-11-00400) 22 
 

ACKNOWLEDGMENTS 

This report was prepared under the direction of Kevin K. Golladay, 

Regional Inspector General for Evaluation and Inspections in the Dallas 

regional office; Blaine Collins, Deputy Regional Inspector General; and 

Ruth Ann Dorrill, Deputy Regional Inspector General. 

Jennifer Gist and Petra Nealy served as co-project leaders for this study. 

Central office staff who provided support include Berivan Demir Neubert, 

Sandy Khoury, and Christine Moritz. 

We would also like to acknowledge the contributions of other Office of 

Evaluation and Inspections regional office staff, including 

Leah K. Bostick. 

Survey and Certification of Home Health Agencies in FY 2010-2011 (OEI-06-11-00400) 23 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Office of Inspector General
 

http://oig.hhs.gov 

The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, as 

amended, is to protect the integrity of the Department of Health and Human Services 

(HHS) programs, as well as the health and welfare of beneficiaries served by those 

programs. This statutory mission is carried out through a nationwide network of audits, 

investigations, and inspections conducted by the following operating components: 

Office of Audit Services 

The Office of Audit Services (OAS) provides auditing services for HHS, either by conducting 

audits with its own audit resources or by overseeing audit work done by others. Audits 

examine the performance of HHS programs and/or its grantees and contractors in carrying 

out their respective responsibilities and are intended to provide independent assessments of 

HHS programs and operations. These assessments help reduce waste, abuse, and 

mismanagement and promote economy and efficiency throughout HHS. 

Office of Evaluation and Inspections 

The Office of Evaluation and Inspections (OEI) conducts national evaluations to provide 

HHS, Congress, and the public with timely, useful, and reliable information on significant 

issues. These evaluations focus on preventing fraud, waste, or abuse and promoting 

economy, efficiency, and effectiveness of departmental programs. To promote impact, OEI 

reports also present practical recommendations for improving program operations. 

Office of Investigations 

The Office of Investigations (OI) conducts criminal, civil, and administrative investigations 

of fraud and misconduct related to HHS programs, operations, and beneficiaries. With 

investigators working in all 50 States and the District of Columbia, OI utilizes its resources 

by actively coordinating with the Department of Justice and other Federal, State, and local 

law enforcement authorities. The investigative efforts of OI often lead to criminal 

convictions, administrative sanctions, and/or civil monetary penalties. 

Office of Counsel to the Inspector General 

The Office of Counsel to the Inspector General (OCIG) provides general legal services to 

OIG, rendering advice and opinions on HHS programs and operations and providing all 

legal support for OIG’s internal operations. OCIG represents OIG in all civil and 

administrative fraud and abuse cases involving HHS programs, including False Claims Act, 

program exclusion, and civil monetary penalty cases. In connection with these cases, OCIG 

also negotiates and monitors corporate integrity agreements. OCIG renders advisory 

opinions, issues compliance program guidance, publishes fraud alerts, and provides other 

guidance to the health care industry concerning the anti-kickback statute and other OIG 

enforcement authorities.