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Audit of CMS Oversight of States' Use of Third-Party Contractors To Conduct Nursing Home Surveys

Announced on  | Last Modified on  | Project Number: A-04-24-08105
Status
Completed
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

Prior OIG reviews of nursing homes have identified multiple issues related to the backlog of required nursing home surveys conducted by State survey agencies. To combat this backlog, State survey agencies have increasingly used third-party contractors to conduct surveys. CMS may also rely on these same third-party contractors to conduct comparative surveys to ensure that States meet Section 1864 requirements. We will review this area to determine whether CMS provides adequate oversight of States' use of third-party contractors to conduct nursing home surveys in accordance with Federal requirements.

TIMELINE

REPORT PUBLISHED

CMS Could Improve Oversight of States' Use of Contract Surveyors for Nursing Home Surveys (A-04-24-08105)
  • CMS did not provide adequate oversight of States’ use of contract surveyors to conduct nursing home surveys.
  • During our audit period, CMS issued a memo to SAs outlining contracting practices SAs could use to ensure that contract surveyors meet Federal requirements, but CMS did not monitor whether SAs implemented practices that achieved the memo’s underlying objectives.
  • Our survey of 14 States that used contract surveyors found that all 14 could have improved their policies and procedures to ensure that the CMS guidelines were met.

In the absence of CMS monitoring and oversight, there is an increased risk that SAs have not implemented sufficient controls to ensure that contract surveyors meet Federal requirements when performing nursing home surveys.

26-A-04-097.01 to CMS - Open Unimplemented
Update expected on 03/01/2027
We recommend that CMS add worker classification (i.e., employee or contractor) as a required entry in iQIES and require CMS and SAs to record the status of each individual performing any nursing home survey (including an FMS).

26-A-04-097.02 to CMS - Open Unimplemented
Update expected on 03/01/2027
We recommend that CMS confirm that SAs have policies and procedures in place to ensure that contract surveyors performing nursing home surveys meet Federal requirements. For example, CMS could verify these policies and procedures during its annual assessment of SAs.

View in Recommendation Tracker
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Contracts Quality of Care
Target Groups
Elderly
Financial Groups
Medicaid