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July 25, 2019

OIG Suggests Using Claims Data to Help Combat Abuse and Neglect

On July 23, 2019, OIG released a resource guide to help public and private payors use diagnosis codes in health insurance claims to identify unreported abuse or neglect of Medicare or Medicaid beneficiaries. OIG created the guide in response to audit reports that “identified tens of thousands of Medicare and Medicaid beneficiaries who were potentially victims of abuse or neglect.” OIG developed a method to help address the instances in which the abuse and neglect goes unreported. The guide is meant to assist public and private sector partners in developing their own processes “to help identify (1) unreported instances of abuse or neglect, (2) beneficiaries or patients who may require immediate intervention to ensure their safety, (3) providers exhibiting patterns of abuse or neglect, and (4) instances in which providers did not comply with mandatory-reporting requirements.” The guide includes a list of diagnosis codes it used to identify potential incidents of physical and sexual abuse, rape, maltreatment, and abandonment.