Why OIG Did This Audit. We previously conducted an audit of CMS’s use of Medicare data to identify incidents of potential abuse or neglect and found that CMS did not use Medicare claims data to identify incidents of abuse or neglect of Medicare enrollees. CMS did not concur with three of our four prior audit recommendations. Our objectives were to determine: (1) the prevalence of incidents of potential abuse or neglect of Medicare enrollees for 2019 and 2020, (2) who may have perpetrated those incidents and where they occurred, and (3) whether the incidents were reported to law enforcement. How OIG Did This Audit. Our audit covered claims from January 2019 through December 2020 for services provided to treat Medicare enrollees with diagnosis codes related to abuse or neglect. We sampled 100 Medicare claims and reviewed the medical records to determine whether they contained evidence of potential abuse or neglect, who perpetrated those incidents, where they occurred, and whether law enforcement was alerted. We also discussed with CMS the reasons for its nonconcurrence with our prior recommendations.
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