Feds step up review of complaints from patients who say they were harmed

Posted at 8:02 AM, Jan 02, 2015
and last updated 2015-01-04 13:41:01-05

Every year, the federal government reviews 100,000 complaints from patients who say they were harmed while receiving medical care. They got surgery they didn't need, drugs that made them sicker, care that took too long to deliver. 

Now, the nation's top health watchdog is stepping up scrutiny of oversight “gaps’’ that allow medical errors to hurt or even kill people, according to a 2015 federal work plan. The Office of Inspector General for the U.S. Department of Health and Human Services also is examining who’s getting care, who isn't and what the repercussions are.

"Access of care, quality of care and drug safety -- those are the pillars we're focusing on," Christi Grimm, chief of staff for the inspector general's office, said in an interview.

The watchdog agency has about 1,500 auditors, criminal investigators, inspectors and lawyers who track fraud and abuse at HHS, the agency that oversees Medicare, Medicaid and other health insurance programs. They cover 100 million Americans – roughly one in three of us -- at a cost of $1 trillion a year.

The Inspector General's Work Plan for 2015 calls for turning up the heat on how HHS supervises doctors, hospitals, nursing homes and other health care providers

"We want to make sure people are getting the right services and the right quality," Grimm said.

One probe centers on a little-known network of private contractors charged with improving care for Medicare recipients.  So-called Quality Improvement Organizations will get more than $700 million in public money next year to reduce cases of incorrectly prescribed medications, preventable infections and other types of patient harm.

HHS’ Centers for Medicare & Medicaid Services is overhauling the quality-improvement program after an independent review questioned its use of resources and potential conflicts of interest with health care providers.

Federal inspectors want to know how those contractors' duties overlap with other patient safety groups.

"There's a lot of skin in that game," Grimm said. "We're looking at where there's duplication in their missions."

Federal inspectors are targeting at least half a dozen other areas of patient safety. Among them:

Pharmaceutical compounding:

The inspector general’s office is examining how hospitals supervise pharmaceutical compounding, or the mixing of drugs to fit a patient’s needs.

Drug compounding came under scrutiny in 2012, when an outbreak of meningitis was linked to contaminated injections of compounded steroids. Those tainted drugs, mixed at an unaccredited Massachusetts compounding pharmacy, caused 64 deaths. The outbreak led to stricter oversight of compounding companies, and now investigators are eyeing compounding practices inside hospitals.

Hospital checks on problem doctors:

Inspectors want to know how hospitals vet doctors before allowing them to admit patients.

"We will determine how hospitals assess medical staff candidates before granting initial privileges, including verification of credentials,’’ according to the 2015 work plan, which notes that a hospital's governing body must hold physicians accountable for the quality of care they provide.

Several reports, including a 2009 probe by Public Citizen, a nonprofit consumer advocacy group, found that hospitals routinely failed to report or take action against physicians with a trail of medical mistakes and malpractice payments.

Problems with care at facilities that treat disabled and chronically ill patients:

Every year, after an injury, illness or surgery, half a million older Americans are admitted to long-term-care hospitals or inpatient rehabilitation centers.

The inspector general’s office is examining how often patients admitted to these facilities are harmed by "adverse events" such as improper medications, preventable infections or avoidable falls.            

Medicare spends more than $12 billion a year for care at these facilities, which are increasingly owned by for-profit companies.

Dental care for kids:

Federal investigators are looking at whether children enrolled in Medicaid, the giant health care program for the poor, get proper access to dental care. Inspectors will review "billing patterns of pediatric dentists and their associated clinics in selected states." 

That review comes after the government prosecuted a number of pediatric dental providers and chains for performing unnecessary dental procedures and harming children.

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