On June 12, 2019, the Office of the Inspector General (OIG) released a report that examined the identification and reporting of potential abuse and neglect occurring within the country’s nursing homes. The agency reviewed documents and reports of approximately 38,000 high-risk emergency room Medicare claims in 2016. The findings suggest that a disturbingly high level of potential mistreatment happens at nursing homes, and the incidents are underreported.
Prevalence of Potential Abuse or Neglect
The OIG selected a sample of 256 high-risk ER visits to determine the prevalence of potential abuse or neglect in nursing homes. Of those surveyed, 51 resulted from potential mistreatment of the patient that should have been reported to authorities. The agency’s findings suggest that 20% of high-risk visits are caused by lack of proper care, and it concluded that, of the 37,607 claims reviewed, an estimated 7,831 were the result of potential abuse or neglect.
Reporting Mistreatment to Officials
Federal and state laws require nursing homes to report instances of potential abuse or neglect to the Survey Agency. From its sample of 51 high-risk claims, the OIG found that 42 nursing facilities did not report the incidents as required. It estimated that, in 2016, 6,608 claims went unreported. When the OIG surveyed the facilities to determine why they did not inform officials about potential abuse or neglect, 35 responded, stating that the incidents did not meet reporting guidelines.
Reporting Substantiated Claims to Local Law Enforcement
When the Survey Agency and Centers for Medicare and Medicaid Services (CMS) receive potential abuse or neglect claims from nursing homes, they are to investigate the incident to determine whether or not it is substantiated. If the investigation proves that mistreatment occurred, the agencies are then required to report the information to local law enforcement. During the OIG’s review, it found 69 incidents of alleged abuse that 5 different Survey Agencies investigated and substantiated. Of those 69, 67 (97%) were not reported to law enforcement.
The Survey Agencies gave different reasons for not reporting, including leaving the responsibility up to the nursing facility, avoiding violating state laws, and informing law enforcement of only serious abuse cases.
The OIG’s Recommendations
The OIG reported that the high instances of nursing home abuse and neglect and the underreporting of these incidents put the health and safety of patients at risk. Failure to inform the proper officials and authorities makes it difficult to pursue legal action against the responsible parties.
The agency recommended that the CMS:
- Provide better training for nursing home staff to increase understanding of reporting requirements
- Provide clear guidelines for what constitutes abuse or neglect
- Require that Survey Agencies record all instances of potential abuse or neglect
- Monitor reports that need to be sent to local law enforcement agencies
Schedule a Free Consultation with Brown & Barron, LLC
When a family makes the tough decision to have their loved one cared for in a nursing home, they trust the facility to provide the needed treatment. Unfortunately, as the OIG report shows, there are many incidents of potential abuse and neglect occurring at these homes. If a patient is harmed as a result of the staff’s negligence or intentional actions, the facility could be held financially responsible for damages.
At Brown & Barron, LLC, we are committed to providing compassionate and dedicated representation to help individuals pursue civil claims against nursing homes where their loved one was mistreated. When you retain our services, we will investigate the matter, interview witnesses, and build a legal strategy to help get the compensation you deserve.
To speak with one of our attorneys, call us at (410) 698-1717 or contact us online.