Serious Reporting Issues When it Comes to Neglect at Skilled Nursing Facilities

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In June, the Office of Inspector General (OIG) performed an audit documenting incidents of potential abuse and neglect at skilled nursing facilities, which cover not only the elderly but also disabled persons. The purpose of the report was to determine:

  • The prevalence and incidence rate resulting in emergency room claims and high-risk diagnosis codes;
  • Whether the incidents were reported in the correct and proper manner; 
  • Whether the Centers for Medicare and Medicaid Services (CMS) and state survey agencies followed through on their duty to report any findings of abuse to the correct law enforcement officials; and
  • The extent to which the CMS requires incidents like these to be recorded and tracked.


One in Five Claims Involve Abuse or Neglect

The OIG looked at close to 38,000 high-risk hospital ER claims for those receiving Medicare benefits and living in skilled nursing facilities throughout 2016. What they found was that 20 percent of high-risk hospital ER Medicare claims were the result of potential neglect or abuse. They also found that the facilities failed to report a number of these incidents to survey agencies and law enforcement in accordance with federal requirements and that the CMS does not require all potential abuse or neglect incidents to be reported to law enforcement and other agencies, nor do they track and record these incidents in their tracking system.

By law, these facilities are required to report all violations – even if just alleged – involving abuse or neglect to the Survey Agency. According to definitions provided by the CMS:

  • Abuse is defined as the intentional and willful infliction of harm or punishing a resident in a manner that results in physical or mental harm
  • Neglect refers to a situation in which healthcare providers fail to supply a resident with the necessary care in order to avoid harm
  • An injury of an “unknown source” is an injury where 1) no one observed the source and it could not be explained by the resident and 2) there are suspicious circumstances involved due to the injury’s extent or location, the number of injuries present at one time, or the number of injuries present over time


The OIG’s Recommendations

As a result of the audit report, the OIG recommended that the CMS:

  • Ensure that these incidents of potential abuse or neglect are identified imported;
  • Work with survey agencies to improve staff training related to how to identify important incidents;
  • Provide guidance in order to help identify potential abuse or neglect;
  • Require that incidents of abuse and neglect be reported and tracked; and
  • Monitor these findings over the long-term.


 South Carolina Nursing Home Abuse Attorneys

If you or a loved one has been subject to nursing home abuse, contact our experienced South Carolina nursing home neglect lawyers today to find out how we can help.

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