OIG: CMS not doing enough to protect nursing home patients
- HHS’ Office of Inspector General issued an alert ahead of a preliminary report on quality of care concerns at skilled nursing facilities (SNF) in the U.S.
- The ongoing review, part of a broader investigation of elder abuse, found 134 cases of Medicare beneficiaries who may have been victims of neglect or abuse between Jan. 1, 2015, and Dec. 31, 2016. A significant share of those incidents, which occurred across 33 states, may not have been reported to law enforcement authorities, according to the report.
- The report calls CMS’ procedures inadequate to protect nursing home residents and makes recommendations on how to ensure patients are well cared for.
The potential incidents in the report include failure to provide patients with needed medical care, as well as physical abuse and sexual assault. Prior audit reports showed that up to 15% of critical cases were not reported to appropriate state agencies. “Our preliminary results combined with these prior report results raise significant concerns that incidents of potential abuse or neglect at SNFs have gone unreported, “the report says.
Under Sec. 1150B of the Social Security Act, federally funded long-term care facilities must report potential cases of abuse or neglect immediately. Failure to do so may result in fines up to $300,000 and exclusion from federal healthcare programs. Skilled nursing facilities are required to report suspected crimes within five days.
The government watchdog urges families to ask loved ones about their treatment in nursing homes and to report suspected abuse or neglect to local police and state Medicaid fraud control units.
To ensure incidents of abuse and neglect are identified and reported, CMS should compare Medicare claims for emergency room treatment and nursing home services and periodically provide the results to state survey agencies for review, the report says. The agency should also work with HHS to establish its authority to impose penalties against facilities where patient harm occurs.
OIG urges CMS to issue regulations on penalties under Sec. 1150B once it has the authority to impose them.
Last September, CMS published a final rule banning forced arbitration clauses in nursing homes with the intent of making it easier for patients to sue after neglect or abuse. The clauses have been used by facilities to hide neglect, elder abuse and other wrongdoing from prospective patients and their families. The new requirement was heralded as a step forward in improving care, safety and consumer protections for individuals residing in long-term care facilities.
The ban never took effect, however. In October, the American Health Care Association sued CMS on grounds the rule violated the Federal Arbitration Act and arbitration is less costly for both sides than going to court. A federal court sided with AHCA, blocking the ban ahead of its Nov. 28 effective date.
Most recently, President Donald Trump's administration has proposed a rule that would allow long-term care facilities to require potential residents sign an arbitration agreement and deny admission if they refuse.
- Office of Inspector General Early Alert: Potential Abuse or Neglect at Skilled Nursing Facilities
- Office of Inspector General Early Alert: The Centers for Medicare & Medicaid Services Has Inadequate Procedures To Ensure That Incidents of Potential Abuse or Neglect at Skilled Nursing Facilities Are Identified and Reported in Accordance With Applicable Requirements