The HHS watchdog agency audited Medicare billing records related to cases in which patients were taken directly to hospital emergency rooms from nursing facilities. It says at least 6,200 patients were affected in 2016 by a large-scale failure of nursing homes and state agencies to report suspected elder abuse.
The report focuses on Medicare claims made three years ago and is part of a larger series of audits, the inspector general’s office says. It released preliminary findings in 2017, but rolled out the completed report Wednesday.
One in five high-risk hospital ER Medicare claims for treatment provided in 2016 were the result of potential abuse or neglect of beneficiaries living in a skilled nursing facility, according to the report.
It found that nursing homes failed to report 6,600 of these incidents to state government survey agencies in accordance with federal requirements, and several state agencies also failed to report some substantiated findings of neglect and abuse to local law enforcement.
In addition, the inspector general determined that the Centers for Medicare and Medicaid Services, or CMS, does not require all incident reports of abuse or neglect to be recorded and tracked in its survey processing system, even if law enforcement is notified.
“Preventing, detecting, and combating elder abuse requires CMS, survey agencies, and [skilled nursing facilities] to meet their responsibilities,” the report says, encouraging CMS to better track the data.
The report specifically recommends CMS compile a list of diagnoses that can be used to identify and address abuse of Medicare beneficiaries during periodic audits of claims.
It also urges the agency to help states ensure compliance with their mandatory reporting laws, and help them access data on potential abuse.
“Improving safety and quality in America’s nursing homes is one of CMS’ top priorities. CMS welcomes the recent attention on nursing home quality of care that has amplified the important national dialogue,” CMS Chief Medical Officer Kate Goodrich said in a statement last week.
The HHS inspector general said CMS agreed to assess the effectiveness of federal regulations, but disagrees with the data-related recommendations.
CMS stated that Medicare claims data “may not be timely enough to address acute problems” in identifying and addressing potential abuse or neglect of Medicare beneficiaries, according to Wednesday’s report.
The quality of nursing homes has been a top issue for CMS since at least 2017, when Seema Verma took over as administrator. The agency recently released a five-part plan to strengthen regulations, but the HHS watchdog said more action is needed.
“CMS has already improved the way nursing homes are surveyed by implementing a robust, standardized survey process, strengthened the staffing requirements for nursing homes, updated the way nursing homes report their staffing to CMS, then targeting nursing homes with staffing problems for off-hours and weekend surveys; and we began to post all of the agency’s surveyor training online,” Goodrich said last week.