OIG Escalates Scrutiny of Antipsychotic Drug Use in Nursing Homes

• By: Maureen Carland
• On: 07/01/2026 09:17:24
• In: Quality/Regulatory

Federal oversight of antipsychotic prescribing in nursing homes is intensifying. In March 2026, the Office of Inspector General published two reports based on inspection reviews finding that some nursing homes administered antipsychotics to manage residents' behavior for staff convenience — despite an FDA boxed warning that these drugs may increase the risk of death in elderly patients with dementia. More concerning, OIG found evidence that facilities were applying inappropriate schizophrenia diagnoses to exclude residents from the antipsychotic quality measure that factors into Five-Star ratings. OIG has now added a nationwide Medicare claims analysis to its Work Plan to determine the full scope of antipsychotic use — and how many of those residents carry a dementia diagnosis.

Maine facilities should note that the regulatory environment around this issue has already tightened considerably. CMS has been conducting MDS schizophrenia audits since 2023, updated surveyor guidance on related F-tags in November 2024, and launched a revised long-stay antipsychotic measure on Care Compare in January 2026 that cross-checks MDS schizophrenia exclusions against claims data. The OIG reports specifically called out the failure of consulting pharmacists and medical directors to identify and push back on inappropriate prescribing — making this a timely area for facilities to review their drug regimen review processes, PRN psychotropic protocols, and the clinical documentation supporting any schizophrenia exclusion on the MDS.

Staff contact: mcarland[at]mehca.org