HHS OIG to Review CMS Citations for Nursing Home Antipsychotic Use 

The Department of Health and Human Services Office of Inspector General (HHS OIG) recently announced its plan to perform an in-depth review of nursing home citations issued by the Centers for Medicare and Medicaid Services (CMS) related to the use of antipsychotic drugs. This comes on the heels of CMS’s recent announcement that it is engaging in a new series of audits intended to address the agency’s concern that nursing homes could be miscoding schizophrenia to reduce their reported rates of antipsychotic use (discussed in a previous alert), and signals a government-wide focus on the use of such drugs at nursing homes.

In announcing their review, which is expected to be issued in 2024, HHS OIG explained that antipsychotic drugs have powerful side effects, particularly among elderly individuals with dementia. HHS OIG has previously raised concerns about the high use of antipsychotic drugs in nursing homes, and about the potential falsification of schizophrenia to mask that usage. HHS OIG plans to conduct a thorough review of nursing home data to identify gaps that lead to the inappropriate use of antipsychotic drugs in nursing homes nationwide.

Nursing home operators should note that taken together, the combined efforts of HHS OIG’s enforcement focus and CMS’s audit focus on the use of antipsychotic drugs in nursing homes indicate a purposeful and likely coordinated government effort to address what it perceives to be the overuse of the these medications. Nursing homes and other facilities should act proactively and, in collaboration with counsel, review their own practices and documentation in order to prepare for possible audits and preemptively correct any issues. Ballard Spahr attorneys in the firm’s Health Care Group are available to assist clients in complying with CMS documentation regulations and to help nursing homes who may be subject to CMS audits.

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