OIG Alerts CMS to Inadequate Patient Abuse Oversight in Skilled Nursing Facilities.

Date posted: September 5, 2017

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently issued an ‘Early Alert’ memorandum to the Centers for Medicare and Medicaid Services (CMS) regarding its oversight of patient abuse in skilled nursing facilities (SNFs). The memorandum alerts CMS to the preliminary results from the OIG’s ongoing audit of potential abuse and neglect in skilled nursing facilities (SNFs). The OIG audit is part of its larger effort to detect and prevent elder abuse. The audit objectives are to: (1) identify incidents of potential Medicare beneficiary abuse or neglect in SNFs; and (2) examine whether the SNFs reported and investigated these incidents in accordance with relevant requirements. The OIG notes that nursing homes do not report more than one in four possible abuse or neglect incidents against nursing home residents, despite strict mandatory reporting laws. Civil monetary fines can reach $300,000 for skilled nursing facilities that fail to comply.

The OIG analyzed emergency department records for 134 Medicare beneficiaries residing in nursing homes. The sample included beneficiaries whose diagnosis codes indicated potential abuse or neglect. The OIG also examined Survey Agency reports for the periods during which the abuse had allegedly occurred. Additionally, the OIG reviewed the Medicare exclusion database and interviewed CMS officials to determine whether HHS had implemented civil monetary penalties or used its exclusion authorities against any providers under section 1150B.

The OIG reported the following findings:

  • Of the records sampled, 75 percent revealed that the beneficiary’s injuries were actually caused by abuse or neglect.
  • The four most common diagnosis codes in the review sample involved alleged rape or other sexual abuse.
  • Of the identified incidents, the nursing homes reported 96 of the identified incidents to local law enforcement within two hours, as required by federal laws in cases of serious injury.
  • The nursing homes failed to report the remaining 38 incidents.

The OIG declared that CMS procedures “are not adequate” to ensure identification and reporting of possible abuse or neglect. This inadequacy is especially notable when comparing Medicare claims for emergency department services with SNF claims, to identify instances of abuse. The OIG noted that CMS has not taken any enforcement actions on the reporting laws since they went into effect in 2011. However, CMS responded by noting that the HHS secretary had not authorized it to enforce the regulation.

The OIG recommended that CMS:

  1. Immediately begin comparing emergency room and SNF claims;
  2. Work with HHS to impose civil monetary penalties for providers who fail to adhere to reporting laws;
  3. Take steps to better protect nursing home patients, including pursing authorization for enforcement; and
  4. Take steps to compare data and better identify possible cases of abuse.

The media has dedicated considerable attention to this particular OIG report. The report and subsequent public concern is likely to instigate congressional hearings and increased federal and state government enforcement actions.

The OIG Early Alert Memorandum is available at:

https://oig.hhs.gov/oas/reports/region1/11700504.pdf

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