WASHINGTON, D.C. — The U.S. Department of Health and Human Services Office of Inspector General has announced a sweeping new audit examining whether nursing homes across the country have adequate pharmacy controls in place to prevent the overuse, misuse, and diversion of opioid medications, according to the OIG's updated Work Plan published February 17, 2026. The review comes as federal data reveals that state survey agencies have cited nearly half of all certified nursing homes nationwide for pharmaceutical services deficiencies during recent inspections.
The investigation, designated Project Number OAS-26-01-027, will focus on determining whether selected state agencies have ensured that nursing homes comply with both federal and state pharmacy service requirements designed to protect Medicare and Medicaid residents from dangerous opioid practices, according to the OIG announcement. More than 157,000 nursing home residents currently receive opioid medications and could face heightened risks if effective internal controls are not in place, the agency stated.
As reported by McKnight's Long-Term Care News, the audit will specifically evaluate whether facilities have implemented effective systems to prevent opioid diversion — the redirection of prescription medications for unauthorized use — as well as overuse and misuse among the nation's most vulnerable patient populations. The study is projected to reach completion in fiscal year 2028, according to the OIG's timeline.
The announcement arrives amid a broader expansion of federal regulatory scrutiny over nursing home operations. According to Skilled Nursing News, the OIG requested $454.4 million for fiscal year 2026, with $367.4 million designated for Medicare and Medicaid oversight. Nursing homes were identified as one of three primary enforcement priorities alongside grants and contracts and managed care programs. The OIG currently oversees more than 15,000 certified facilities serving approximately 1.2 million residents across the country.
Federal regulations require nursing homes to provide comprehensive pharmaceutical services, including procedures that ensure the accurate acquisition, receipt, dispensing, and administration of all medications. Facilities must store all drugs in locked compartments, restrict access to authorized personnel only, and maintain separately locked, permanently affixed storage for Schedule II controlled substances, which include most opioid medications.
As reported by Healthicity, the opioid pharmacy controls project was one of four new items added to the OIG's February 2026 Work Plan, signaling an intensified enforcement posture. The additions collectively target nursing home pharmacy oversight, Medicaid reimbursement practices, state financing mechanisms, and prescription drug access for dual-eligible beneficiaries. The pattern reflects what industry observers describe as a sustained federal focus on medication safety within long-term care settings.
This is not the OIG's first foray into nursing home drug safety investigations. According to CMS Compliance Group, the agency previously added an audit of nursing facility drug overdoses to its Work Plan in 2024, examining whether facilities complied with quality-of-care requirements and properly reported and investigated overdose incidents. That earlier review also assessed whether nursing homes implemented corrective actions following opioid-related incidents.
CMS Inspection History
The federal review carries particular relevance for facilities with documented compliance challenges. Mt Angel Health and Rehabilitation, a 93-bed nonprofit facility in Mount Angel, Oregon, illustrates the kind of pharmaceutical and care quality concerns that federal investigators may examine under the new audit.
According to CMS inspection records, Mt Angel Health and Rehabilitation currently holds an overall rating of just 2 out of 5 stars, with a matching 2-star health inspection rating. The facility has accumulated 61 total deficiencies across 12 inspections on record with CMS, with the most recent survey conducted on February 14, 2025.
The facility's recent deficiency history includes citations directly related to care delivery and resident protection. During its February 2025 inspection, surveyors cited Mt Angel for failing to provide appropriate treatment and care according to physician orders and resident preferences, a Severity Level D deficiency indicating the potential for more than minimal harm, according to CMS records.
More concerning, an April 2024 inspection resulted in a Severity Level G citation — indicating actual harm — for failure to protect residents from all types of abuse including physical, mental, and sexual abuse, as well as physical punishment and neglect. That same abuse-prevention deficiency appeared again during a March 2024 survey at the lower D severity level, alongside another citation for inadequate treatment and care delivery.
While Mt Angel maintains a stronger 4-star staffing rating and a 3-star quality measure rating, the pattern of care-related deficiencies underscores why federal regulators are expanding their oversight of medication management and resident safety across the nation's nursing home system.
Ownership & Operations
Mt Angel Health and Rehabilitation operates as a nonprofit corporation, according to CMS records. The OIG's new audit is expected to examine facilities across various ownership structures, as pharmaceutical services compliance failures have been documented at both for-profit and nonprofit nursing homes nationwide. The agency's prior enforcement data shows it recovered approximately $11 for every $1 invested in oversight activities, with more than $7 billion in expected recoveries reported in 2024, according to Skilled Nursing News.
Resources for Families
Families with concerns about medication management or opioid safety at Oregon nursing homes can contact the Oregon Long-Term Care Ombudsman at 1-800-522-2602. The ombudsman program provides free, confidential assistance to residents and families navigating quality-of-care issues, filing complaints, and understanding their rights under federal and state law.
The National Long-Term Care Ombudsman Resource Center can be reached at 1-800-677-1116 or online at [ltcombudsman.org](https://ltcombudsman.org). Families may also file complaints directly with their state survey agency or contact CMS to report concerns about pharmaceutical services or resident safety at any Medicare- or Medicaid-certified nursing home.
Residents and family members who suspect opioid diversion or medication misuse should report concerns immediately to both the facility administrator and the appropriate state licensing authority. Federal law requires nursing homes to investigate and address all reported concerns related to medication safety and resident well-being.
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