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Followup Audit on CMS's Use of Medicare Data To Identify Instances of Potential Abuse or Neglect

A prior audit (A-01-17-00513) identified 34,664 Medicare claims containing diagnosis codes that indicated Medicare beneficiaries were treated for injuries possibly caused by abuse or neglect from January 1, 2015, through June 30, 2017. It estimated that 30,754 of these Medicare claims were supported by medical records that contained evidence of potential abuse or neglect. CMS did not identify the Medicare claims that indicate potential abuse or neglect because, according to CMS officials, it did not extract data consisting of Medicare claims with diagnosis codes related to abuse or neglect. The lack of a data extract impeded the ability of CMS and public and patient safety organizations to pursue legal, administrative, and other appropriate remedies to ensure the safety, health, and rights of Medicare beneficiaries. This audit is a followup to determine whether CMS improved its use of Medicare data to identify incidents of potential abuse and neglect since we issued our previous report. We will also determine: (1) the prevalence of incidents of potential abuse or neglect of Medicare beneficiaries in 2019 and 2020, (2) who may have perpetrated those incidents and where they occurred, (3) and whether the incidents were reported to law enforcement.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Completed Centers for Medicare and Medicaid Services Followup Audit on CMS's Use of Medicare Data To Identify Instances of Potential Abuse or Neglect Office of Audit Services W-00-22-35882;