Sen. Bob Casey (D-PA), chairman of the Senate Special Committee on Aging, noted that nearly 4 million older adults reported having a substance use disorder in 2022, with 1.8 million of those involving drug use. Mortality from drug overdoses among seniors also more than tripled between 2000 and 2022, he added, citing federal data. 

“Older adults are not immune to these issues, and this a growing and evolving crisis in America,” Casey said in opening the hearing, which focused both on access to opioids and gaps in care. 

“Older adults tend to be overlooked for substance use disorders in typical screenings and prevention efforts, even though they are more susceptible to developing substance use disorders than other age groups and at higher risk of undiagnosed and untreated substance use disorders,” he added. “The people, the problems and the solutions remain largely invisible to our society.”

Nursing homes are increasingly being called on to treat patients with substance use disorders, with both federal regulators and state law enforcement officials reminding facilities that they cannot turn away such patients when they are also in need of skilled care.

Some nursing homes have begun to specialize in providing such care, particularly for opioid-addicted patients requiring administration of suboxone treatments.

OIG keeps focus on needs, treatment access

Thursday’s hearing coincided with the publication of an annual brief from the Health and Human Services Office of Inspector General that examines access to treatment for opioid use disorder and the opioid overdose-reversal drug naloxone.

It found that about 52,000 Medicare enrollees experienced an opioid overdose in 2022. Of the 1.1 million enrollees who have opioid use disorder, just 18% received medication to treat that disorder. In some states, the OIG found far lower access, with Florida the worst with just 6% receiving treatment medication.

While naloxone has been an important tool in addressing the nation’s opioid crisis — one Senate witness credited with “saving countless Americans from death” — it last year became an over-the-counter medication. That could mean less affordable access for some Medicare patients, and the OIG warned CMS to make sure providers know how to educate patients and prepare for additional need.

The OIG report recognized that CMS and the department “had taken a number of actions” to increase access to suboxone and other opioid use disorder treatments. 

“However, the low percentage of enrollees receiving medication to treat their opioid use disorder calls for additional action,” the report said.

David Skoczulek, vice president of business development and communications at Connecticut-based iCare Health Network, said providing access to “patient-centered, specialized substance use treatment and care in the skilled nursing setting is critical.”

“Substance use disorder crosses all social and demographic lines,” he added. “The need for these services is not going away and it’s not even appearing to ebb over time. We will be living with the impacts of the opioid epidemic for a very long time in all aspects of healthcare, and skilled nursing care is not an exception. It’s highly prevalent and we will need increasing supports, access and coverage to provide quality care to these individuals.”

Medicare coverage gaps remain 

Much of the conversation Thursday revolved around the inability of Medicare-covered seniors to access residential treatment and other services under either traditional or managed care plans.

While commercial insurance providers in the US must provide parity in the way they cover physical health needs and behavioral health needs, the Medicare system has not been changed to reflect that standard.

“Older adults and people with disabilities deserve non-discriminatory coverage of substance use disorder and mental health treatment,” said Deborah Steinberg, senior health policy attorney at the Legal Action Center. “We urge you to ensure that Medicare beneficiaries do not continue to be left behind.”

She pointed to the 2018 SUPPORT Act, which first added coverage of opioid use treatment to Medicare, as the start of improved treatment for opioid use disorder. This year, Congress included coverage of addiction counselors (under the umbrella of mental health counselors) and intensive outpatient treatment in its consolidated appropriations bill.

And CMS has also issued regulatory guidance and coding to make sure beneficiaries have more access to peer support specialists and community health workers, Steinberg noted. The agency also increased Medicare reimbursement for psychotherapy and office-based substance use treatment to “address barriers to provider participation,” Steinberg said.

Nursing homes, however, aren’t paid extra by the federal government for substance use disorder care provided to their residents, despite its additional staffing and safety demands and costly counseling services. State Medicaid plans, however, do in some cases help offset the cost of bringing in behavioral health professionals.

Also Thursday, Sen. Mike Braun (R-IN), the committee’s ranking member, issued a new report emphasizing concerns about the illicit opioid trade and the increasing ways seniors may interact with fentanyl-laced drugs.

“Despite [a] dramatic increase in overdoses due to synthetics, prevention messaging for older adults still reflects traditional concerns about prescription opioid misuse but does not focus on synthetics like fentanyl increasingly infecting drugs taken by older Americans,” the report stated.

Health, life safety and emergency preparedness deficiencies were underreported at an estimated two-thirds of all US nursing homes in 2020,  the Department of Health and Human Services Office of Inspector General said in issuing an audit report Tuesday.

“CMS examined the root causes of OIG’s findings, and — while the audit review sample size only included 100 nursing homes — CMS takes the findings seriously and has already corrected each issue identified,” a CMS spokesperson told McKnight’s Long-Term Care News in an email Wednesday. 

“The issues identified in this audit did not have a meaningful impact on the way a consumer would perceive the quality of care provided by a nursing home; nearly all of the issues described in the report did not affect the Five-Star Quality Ratings displayed on Care Compare,” the agency added.

But the audit, which follows one of a similar nature in 2004, brings renewed attention to accuracy and might ultimately lead to providers having more negative survey results highlighted online. The OIG recommended that CMS add more manual checks of Care Compare data  to ensure it accurately reflects inspection reports. It also called on better training for state surveyors and others involved in translating survey findings into online postings.

But the audit also raises questions about the agency’s overall approach to regulation and transparency.

“Providers and consumers alike rely on the Center for Medicare & Medicaid Services, the government agency responsible for nursing home quality oversight, to deliver reliable and accurate data on care delivery,” said Janine Finck-Boyle, vice president of health policy for LeadingAge. “The HHS’ OIG report findings raise serious questions about CMS’ ability to do that. While the OIG sample is small, the results further reinforce the April 2022 National Academies of Science, Engineering and Medicine Committee’s call for wide-ranging, systemic change in America’s nursing homes — including a more effective approach to regulation.” 

Association wants changes

The American Health Care Association said it supported efforts to resolve issues identified by the OIG. But it also sought to illustrate continued inaccuracies as another reason to improve CMS’ approach to nursing home regulation.

“Especially coming out of the pandemic, this situation also presents an opportunity to reconsider the status quo,” AHCA told McKnight’s late Wednesday. “The current survey and enforcement system has been shown to be inconsistent and ineffective, and one of our major reform proposals includes improving the oversight process. We will continue to advocate for this improvement.”

As noted by CMS in its statement to McKnight’s, the Care Compare website and its Five-Star Quality Rating System pull data from more than 250,000 health, infection control, complaint, and fire safety compliance inspection surveys compiled by roughly 5,000 surveyors for over 15,000 nursing homes.

Given the large amount of data needed to calculate the ratings, CMS has enacted a series of “validation checks to ensure the data files are correctly displayed,” the agency said, noting that it had made some changes between the data used for the 2020 audit and its publication this week. The agency said it would continue to work with OIG to make improvements.

Jessica Curtis, managing partner for Formation Healthcare, noted that 100 facilities is a “really small sample to review.” She said she was uncertain whether OIG’s extrapolation that 10,303 nursing homes were likely affected by missing deficiencies is itself accurate.

“We do not see that level of discrepancy in our real-time Quality In-Cite data coming from state survey documents compared to Care Compare, and our sample size is much larger,” Curtis said.

Her system, however, sees near real-time stats, while the audit looked at findings from those 100 nursing homes in 2020. CMS said many deficiencies from that time, and potential reporting lapses that led to them, are no longer in play.

Another reason for worry

Still, any questions about accuracy remain a concern for providers whose quality is measured by CMS and listed publicly for the world to see. Curtis pointed out a new wrinkle, too: While consumers may be hurt by missing information, wrong information also could affect competing facilities that receive lower Five-Star ratings due to a peer with data discrepancies being rated higher than deserved. 

“It definitely sounds like their data transmission and QA processes have a lot of room for improvement,” Curtis said of CMS. “We do think that erroneous and missing data can often have ‘a meaningful impact on the way a consumer would perceive the quality of care provided by a nursing home,’ especially when it comes to being aware of the current data.”

In addition to making its information more accurate, she urged CMS to speed up the process by which it gets surveyors’ information to consumers.

“Many families, lenders and owners are making important decisions based off of outdated information which does not reflect the current quality issues,” Curtis added. “Perhaps a more automated and thorough transmission and QA process would allow for more timely public availability as well.”

The report, issued early Wednesday by the Department of Health and Human Services Office of Inspector General, also found that the Centers for Medicare & Medicaid Services sometimes reported deficiencies to Care Compare that were not found in survey documentation. Scope and severity levels were also inaccurate for one out of every three nursing homes reviewed in a small sample, the OIG said.

While the OIG’s attention was trained on CMS, the findings also stand to malign nursing homes by reinforcing the idea that deficiencies are widespread in the sector. It could also lead to renewed CMS attention to public reporting accuracy, which in some cases could benefit consumers and nursing homes.

“Consumers rely on the information they find on Care Compare to make informed healthcare decisions and expect it to be accurate; the information can set the expectation for a consumer’s experience with a particular nursing home,” the OIG said in a report reviewed exclusively by McKnight’s Long-Term Care News Tuesday. 

“The findings in this report demonstrate the need for CMS to take additional measures to ensure that the information it reports on Care Compare for nursing homes is accurate.”

OIG said CMS’ processes for reviewing inspection results both before and after they were reported on Care Compare “were not adequate.” Though CMS hires contractors to upload deficiency information to Care Compare, OIG found the agency relied on state survey staff to confirm accuracy after posting and on nursing homes to self-report inaccuracies.

CMS had not replied to a McKnight’s request for comment by deadline.

The OIG audit was based on a sample of 100 nursing homes and their Care Compare listings. Overall, the watchdog found that there were missed deficiencies in 67 cases.

Those included missed health deficiencies for 34 nursing homes — one of which was a J-level deficiency issued during a complaint inspection following the fire-related death of a patient who used in-room oxygen. 

OIG also found missing fire safety deficiencies for 52 nursing homes, and emergency preparedness deficiencies missing for two nursing homes. In addition, for 42 of the 100 sampled nursing homes, CMS did not report results on Care Compare about the yearly fire safety and emergency preparedness inspections. Each sample was compared to deficiencies documented in state surveyors’ inspection and complaint reports dating back three years.

Extrapolating that, OIG estimated inaccurate deficiency listings for 10,303 of the nation’s 15,377 nursing homes at the time the samples were pulled in December 2020.

Care Compare accuracy getting worse?

The audit comes nearly 20 years after a similar investigation. This version appears to show that CMS lapses have increased. 

In June 2004, OIG found that Nursing Home Compare, as it was then known, was missing one or more deficiencies in 11% of nursing homes and was missing inspection results for one or more of the three most recent inspections in 19% of nursing homes. 

At that time, the audit showed deficiencies that were not identified in inspection reports were appearing on public pages for 15% of nursing homes.

That problem continues, especially after facilities use the independent dispute resolution process. Inaccurate reporting that could harm nursing homes’ reputations even after appeals is still getting through to Care Compare. In this report, among a subsample of 34 nursing homes, nine had 23 health deficiencies posted for which the OIG could not find any supporting deficiency documented in an inspection report. That represents more than a quarter of the subsample.

In another alarming section, OIG related extensive concerns about fire and life safety reporting into Care Compare. In a look at 52 nursing homes, the watchdog found 231 deficiencies were missing across 41 of the facilities. In 18 of the 41 nursing homes, all of the fire safety deficiencies identified during inspections were missing from Care Compare. 

Those deficiencies ranged from D-level to F-level and included deficiencies for failure to test and maintain the fire alarm and sprinkler systems, conduct fire drills, to keep full and empty oxygen tanks separated, and install and maintain portable fire extinguishers.

CMS officials told OIG auditors that programming it used to export data from CASPER to Care Compare was not correct and caused approximately 35,000 fire safety deficiencies from three years of annual and complaint inspections not to be reported, the report said.

After the OIG’s work began, CMS updated the coding error and changed some information to reflect shortcomings in the nursing homes included in the sample.

Otherwise, OIG said CMS and its contractors’ data validation checks were not adequate for ensuring accuracy. The OIG found that a manual quality assurance check CMS used to verify that Care Compare reflected updated information was triggered largely by a change to a nursing home’s quality rating and was performed for only a small number of nursing homes. It “was not designed to verify whether nursing home deficiencies reported on the website were accurate.”

CMS responds to concerns

Among several process-driven changes recommend by OIG was a call for CMS to strengthen review of Care Compare data by:

• Requiring state survey agencies to verify that deficiencies shown in the Automated Survey Processing Environment (ASPEN) are also shown in CASPER when they are preparing to conduct an inspection,
• Providing technical assistance and additional training to state survey agencies that are not following procedures in the State Operations Manual and ASPEN Central Office Procedures Guide for reporting deficiencies in ASPEN, and
• Including in its manual quality assurance check a verification that nursing home inspection results are accurately reported.

In its response included in the report, CMS said that it already offers surveyor training through its website but that it “will explore ways to provide additional technical assistance and training.”

CMS also said that it had discovered several primary causes for issues identified in the audit and had “worked expeditiously to resolve them.”

Regarding health deficiencies, CMS said one reason for data discrepancies was a system issue that caused inspection results to overwrite previously entered inspections that were performed on the same day but entered into the system on different days. CMS stated that it corrected the issue with a coding update. CMS also said “it found a few instances of human error” during its review of the findings but “does not believe these occasional instances heavily impact the Five-Star Quality Rating System.”

CMS also noted that several of the findings were related to data that is no longer factored into current Care Compare data.

More than 90% of nursing home workers received their required COVID-19 vaccine doses following the implementation of a federal mandate, according to an estimate by the Office of Inspector General.

The OIG also found that 6% have been granted religious exemptions, with about 24% of religious exemptions in the nation’s Heartland. 

The findings were released Monday in a new report analyzing the COVID-19 vaccination status of nursing home workers as of March 2022. The OIG used a sample size of 1,000 nursing home workers from across the U.S. 

Data showed that 884 of the employees had received the required vaccine dose, with 506 of them receiving a booster dose. It also found that 78 had been granted a religious exemption from receiving the vaccine, 12 were partially vaccinated and three received medical exemptions. The remaining 23 had applied for an exemption that was currently in review or their vaccination status was not clearly documented. 

The OIG based on the findings estimated that 91% of staff nationwide have been vaccinated, while 56% have received a booster dose. At the time the audit was conducted, nursing home staff had accounted for approximately 1.1 million confirmed cases and approximately 2,400 deaths

The report revealed that the percentage of nursing home staff who received the required vaccines varied among the Department of Health and Human Services’ 10 regions.

Specifically, the percentage of nursing home staff who received the required vaccine doses was lowest in the Midwest (Region 5) at 70% and the Heartland (Region 7) at 71%, while the highest percentage was found in the Northeast (Region 1) with 99%. Overall,  four of the 10 regions had a percentage of 95% or higher.

The percentage of nursing home staff granted a religious exemption also varied across the 10 regions, from 1% to 24%. The percentage of workers with an exemption was below 10% in eight out of the 10 regions.

An OIG spokeswoman told McKnight’s Long-Term Care News that it does not have plans to “further assess religious exemptions granted for nursing home staff.” 

The agency’s report comes after a May study found that the healthcare worker vaccine mandate boosted nursing home workers COVID-19 vaccination rates by 25%.

Investigators with the Department of Health and Human Services Office of the Inspector General reviewed medical records of 770 patients discharged from hospitals in 2018. One in 4 of these adults was found to have temporary or lasting harm, including “adverse events” that either led to longer hospital stays or caused “permanent harm, death or that required life-saving intervention,” according to USA Today.

The OIG is pushing for Medicare’s pay-for-performance program to evaluate a wider array of hospital-related health complications. Hospitals do not currently face reduced payments for the vast majority of complications, USA Today reported. There were also lost gains in safety during the pandemic, such as a surge in “central line” catheter infections during the early pandemic in 2020. 

But hospitals likely will recover from these COVID-19 related safety shortfalls, one expert told the news outlet. Medicare’s 1% payment reductions for poor performers, for example, will likely motivate change, said Michael Ramsey, M.D., CEO of the Patient Safety Movement Foundation, an Irvine, California-based nonprofit.

“It’s got to come from the top down,” he said. “You’ve got to have the board’s bonuses based on safety in the hospital, all the way down to the lowest-paid person.”

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Skilled nursing providers are demanding changes after a new federal report found that Medicare Advantage organizations (MAOs) have improperly denied or delayed services to beneficiaries to increase profits. 

The experience is all too common for SNFs that have struggled to admit some residents due to the issue in recent years.

“Every time we have a resident referral who has an MA plan, we know we are in for a fight,” said Rick Holloway, administrator of the Idaho State Veterans Home in Boise. “There has never been an easy admission of a resident who has MA.” 

The report was released Thursday by the Office of Inspector General. The OIG accused MAOs of sometimes delaying or denying Medicare Advantage beneficiaries’ access to services, even though the requests met Medicare coverage rules. 

The report also found that MA organizations denied payments to providers for some services that met both Medicare coverage rules and MAO billing rules. Post-acute facilities were among the healthcare services often involved in denials that met Medicare coverage rules, the OIG said. 

“In some cases, we have had preliminary approvals, then retroactive denials resulting in months of data submissions and appeals to get paid,” Holloway told McKnight’s Long-Term Care News on Friday.   

Call for Medicare reform

He added that it is “well known” in the industry that a resident who is covered under MA will have a length of stay between seven and 20 days, and rarely do providers get approved for therapy beyond that. He said that considering many residents who are admitted directly from the hospital are too sick and frail to start therapy immediately, his facility usually can only get 10 days of therapy before it is forced to discharge.

“There has to be something Medicare can do to stop these MA plans from profiting on the backs of our precious elderly,” Holloway said. 

“Many skilled facilities have the same experience with MA programs.  I truly think they give the policyholders an incorrect picture of what they cover,” he later added. 

Although some of these practices are longstanding, now that Medicare Advantage plan penetration is growing so rapidly, it is more important than ever that these plans apply the same coverage rules as traditional Medicare, emphasized Brian Ellsworth, vice president for public policy and payment transformation at Health Dimensions Group. 

“When providers have appropriate documentation, they should get paid with minimum hassle factor. Unfortunately, this has not always been the case,” Ellsworth told McKnight’s Friday. 

The OIG also found 13% of prior authorization requests that MA plans denied met Medicare coverage rules. In addition, it determined that 18% of payment requests that were denied met Medicare coverage and billing rules.

The Center for Advocacy said that there’s reason to believe the report’s estimates of MA denial rates are on the conservative side, given recent findings from artificial intelligence-driven, decision-making tools show even higher rates. 

“The use of these post-acute care management companies and their AI-driven decision-making tools, in our experience, has led to frequent and repeated denials of care — sometimes every few days — even when individuals still require medically necessary SNF care,” said David Lipschutz, the center’s director.

A government watchdog is urging the Centers for Medicare & Medicaid Services to keep a more watchful eye on facility-initiated discharges after finding nursing homes rarely complied with federal requirements to notify ombudsmen of intended moves. 

An analysis issued Monday by the Health and Human Services’ Office of the Inspector General revealed that a majority of ombudsmen reported they struggled to get timely, complete and accurate facility-initiated discharge notices.

“Providers could look to their ombudsmen and again look to those requirements about the six allowable reasons for discharges, and properly filling out those notices and make sure they’re following those regulations,” Shanna Weitz, the report’s lead analyst, told McKnight’s Long-Term Cares News on Friday. 

Investigators called on CMS to provide more training to nursing homes on federal requirements for facility-initiated discharge notices and to implement deferred initiatives aimed at addressing inappropriate notices. 

The OIG also recommended that CMS assess the effectiveness of its enforcement actions in cases of non-compliant facility-initiated discharge. The agency agreed with the three recommendations but noted that its enforcement evaluation could take time due to the ongoing public health emergency.  

The report also criticized a lack of data on facility-initiated discharges by nursing homes. While nursing homes are required to send discharge notices to state ombudsmen, neither CMS nor the Administration for Community Living collect data on the number of discharges that take place. State ombudsmen also don’t count or track the number of notices they receive. Consumer advocates have criticized nursing home discharge policies during the pandemic as a way to get rid of unwanted patients, and experts had predicted reform on the matter could come under the Biden administration

“The best [way] to help keep nursing homes safe is we need to have information about the number and the nature of these facility-initiated discharges,” Weitz said.

The spike amounts to 169,291 more deaths in 2020 than if the mortality rate had remained the same as in 2019. That’s out of the 3.1 million Medicare beneficiaries who resided in nursing homes in 2020. 

Harvard health policy expert David Grabowski, Ph.D., said those who work in the field “knew this was going to be bad” but didn’t think “it was going to be this bad.” 

“This was not individuals who were going to die anyway,” Grabowski told the Associated Press. “We are talking about a really big number of excess deaths.”

Each month of 2020 had a higher mortality rate than the corresponding month a year earlier. In April 2020 alone, a total of 81,484 Medicare beneficiaries in nursing homes died — more than twice the number in April 2019.

Federal investigators added that the data shows the pandemic had “far-reaching implications for all nursing home beneficiaries, beyond those who had or likely had COVID-19.” 

“The COVID-19 pandemic has been devastating for Medicare beneficiaries in nursing homes,” the government watchdog agency wrote. “The toll that the COVID pandemic has taken on Medicare beneficiaries in nursing homes demonstrates the need for increased action to mitigate the effects of the ongoing pandemic and to avert such tragedies from occurring in the future.”  

The report, which was released by the OIG Tuesday, is the first in a three-part series focusing on the impact of COVID-19 in nursing homes. Upcoming analyses are expected to focus on strategies nursing homes have used to combat the pandemic. 

The findings also revealed that about two in five Medicare beneficiaries (42%, or about 1.3 million), in nursing homes had or likely had COVID-19 in 2020. The number of infected beneficiaries swelled dramatically during the spring of 2020, with just over 21,000 diagnosed as having or likely having the disease between January and March. By the end of June, the number was close to 419,000. 

Federal researchers also found about half of Black, Hispanic and Asian beneficiaries in nursing homes had or likely had COVID-19 in 2020. Each group was also more likely than their white counterparts to contract the disease. 

Investigators concluded that the analysis shows the “value of using Medicare data to understand the extent to which nursing home residents nationwide have been affected by the pandemic, who they were, and what characteristics are associated with greater risk.” 

“These data are important to understanding the effects of the pandemic and, moving forward, could play an integral part in understanding health disparities within the nursing home population and preparing for and dealing with future public health crises,” the report states.

CMS was tasked with strengthening its oversight of nursing home staffing in a report released Thursday by the Department of Health and Human Services’ Office of the Inspector General. It analyzed the agency’s use of staffing data since its switch to the Care Compare site.

The OIG said that, while CMS has taken steps to build a new source of data on nursing home staffing using Care Compare, it should pursue opportunities to better use the information to help consumers and surveyors.

Analysts, led by Lucio Verani in the OIG Office of Evaluation and Inspections, said CMS could improve its staffing oversight in two ways: by annually sharing information about nursing homes directly with state survey agencies and by more fully integrating staffing data into its survey software. 

The watchdog agency noted CMS already shares information with surveyors but in “limited capacity” by providing a list of nursing homes that have potentially insufficient staffing on weekends. However, the OIG said CMS can build on that effort in several ways. 

For example, CMS could tell surveyors which nursing homes reported fewer hours for registered nurses and licensed nurses than what’s federally required and, in turn, help them more efficiently oversee the staffing requirements.

The agency could also share when a provider frequently reports days with no RN hours, which would allow inspectors to specifically target their documentation reviews to the most relevant dates when RNs might not have been working, the OIG urged. 

CMS, which agreed with the recommendation, said it will work to more efficiently provide useful staffing information directly to surveyors. In its written response, the agency also “reiterated that staffing is a vital component of the quality of care in nursing homes” and “emphasized its commitment to continually improve oversight of nursing homes.” 

The recommendations don’t “seek to change the inspection process,” an OIG spokesman told McKnight’s Long-Term Care News in a statement.

“Similarly, our report did not recommend that [state survey agencies] cite nursing homes for insufficient staffing simply because the nursing homes reported staffing levels that fall below federal requirements,” the spokesman added. 

Other report recommendations called on CMS to provide data to consumers on nurse staff turnover and tenure, ensure the accuracy of non-nurse staffing data used on Care Compare, and consider residents’ level of need when identifying nursing homes for weekend inspections. CMS concurred with these recommendations, as well.

Last month, researchers from the University of California Los Angeles and Harvard Medical School suggested CMS add staff turnover to its star ratings, saying it would hold providers accountable for understaffing and provide consumers valuable information about care delivery.

An Office of Inspector General report released Thursday analyzed three contracts for strategic communications services worth a total of $6.4 million between June 2017 and April 2019. The investigation stemmed from a POLITICO report that questioned the legality of the contracts, which benefited GOP-aligned communication consultants.

Though CMS prepared the required documentation for awarding the contracts in accordance with federal regulations, it did not administer and manage the contracts properly, according to the OIG.

The report noted that during those years, CMS had between 221 to 234 full-time employees dedicated to Office of Communications functions, with eight to 15 vacant full-time positions. CMS stated that it requested contract support for strategic communications services based on the needs of the office and that the department could not manage everything with the number of staff it had, according to the report. 

The investigation also found that CMS allowed contractors to make managerial decisions and direct agency employees, and that the agency managed the contracts as personal services contracts. By doing so, CMS created the appearance of an employer-employee relationship between the government and contractor personnel. 

CMS has “deep concerns with [the] OIG’s findings and believes the report’s conclusions are based on unsubstantiated assumptions and incomplete analyses” in response to the report, the agency said. It added that the report relies on mischaracterizations of contractor tasks and duties as well as misinterpretations of the [Federal Acquisition Regulation] and its requirements.

Among its recommendations, the OIG called on the Department of Health and Human Services to review any active HHS contractors or subcontractors or CMS service contracts or task orders. It also called on CMS to review contractor invoices for questionable costs and take appropriate action to recoup any improper payments. 

HHS agreed with and plans to implement the recommendations.