According to an ongoing review of incidents of elder abuse and neglect in skilled nursing facilities and nursing homes, the OIG determined that problems still remain with the quality of care being delivered and the reporting and investigation of such incidents.
Regulations mandate that SNFs ensure that all alleged violations, such as mistreatment, neglect, or abuse (including injuries of unknown source) and misappropriation of resident property, are reported immediately to the administrator of the facility and to other officials, including the Survey Agency, in accordance with State law through established procedures. Furthermore, SNFs are required to investigate these allegations and report the results of the investigation within five days to the administrator of the facility and to other officials, including the Survey Agency, and if the alleged violation is verified, appropriate corrective action must be taken.
In a recent OIG audit, the agency identified 134 Medicare beneficiaries from three different states whose injuries may have been the result of potential abuse or neglect that occurred between January 2015 and December 2016. Audit results determined that more than 25% of these incidents may not have been reported to law enforcement. The most common diagnoses for injury included alleged rape and sexual abuse.
As a result, the OIG determined that CMS has inadequate procedures to ensure that incidents of potential abuse and neglect of Medicare beneficiaries in SNFs are identified and reported. Specifically, CMS admitted that they do not compare Medicare claims for reimbursement of emergency room services with claims for reimbursement of SNF services in order to identify instances of potential abuse or neglect. CMS has also failed to take enforcement action or penalties to ensure that SNF employees are reporting incidents of potential abuse or neglect.
While the OIG writes that they “acknowledge that CMS is committed to providing oversight of health care providers’ compliance with standards to ensure the health and safety of Medicare beneficiaries,” the agency suggests that CMS take immediate action to solve the problem of unreported incidents of abuse/neglect. These immediate actions include comparing Medicare claims for emergency room treatment with claims for SNF services to identify incidents of potential abuse or neglect and continuing to work with the HHS Office of the Secretary to receive the delegation of authority to impose civil monetary penalties for incidents of unreported abuse/neglect.