OIG Audit Reveals Inadequate Abuse Protections for Skilled Nursing Residents

Abuses at skilled nursing facilities frequently go unreported, the Department of Health and Human Services (HHS) determined in a new report that also accused the Centers for Medicare & Medicaid Services (CMS) of not doing enough to protect residents.

HHS’s Office of the Inspector General (OIG) reviewed the emergency room records for 134 Medicare beneficiaries with any of 12 diagnoses that could indicate abuse or neglect, from January 1, 2015 through December 31, 2016. Of those records, 96, or 72% of the incidents, were reported to local law enforcement.

There was no evidence in the hospital records that the remaining 28% of incidents were reported to local law enforcement, even though state reporting laws require hospital medical staff to file these reports.

“We determined that CMS procedures are not adequate to ensure that incidents of potential abuse or neglect of Medicare beneficiaries residing in SNFs are identified and reported,” the OIG report states.

Furthermore, HHS noted that CMS has not enforced abuse-reporting requirements mandated under the Social Security Act since their effective date of March 23, 2011. The State Operations Manual was not updated to include the regulations until March 8, 2017, with an effective date of November 28, 2017.

CMS told OIG that it has not taken enforcement actions because the HHS has not delegated the enforcement of the rule to CMS. CMS began working with the HHS Office of the Secretary in June to receive the delegation of authority, according to the OIG audit report.

Additionally, CMS officials told OIG that they have not taken action to enforce the reporting rule because it has not identified instances in which a covered individual — defined as owners, employees, and contractors at SNFs — has failed to report a case of potential abuse of a Medicare beneficiary.

The OIG report included a list of suggestions for immediate actions that CMS should take to ensure that incidents of potential abuse or neglect in SNFs are reported. These include implementing procedures to compare Medicare claims for emergency room treatments with claims for SNF services, continuing to work with the HHS Office of the Secretary to receive the delegation of authority on the rule, and to ensure the the State Operations Manual is updated and effective by November 28.

Written by Elizabeth Jakaitis

Leave a Reply