Inspector General Audit Could Impact Skilled Nursing Facilities

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September 12, 2017

Skilled nursing facilities (SNF) may see even more scrutiny from the Centers of Medicare and Medicaid Services (CMS) because of a recent audit conducted by the Office of Inspector General of the U.S. Department of Health and Human Services.  The audit looked into abuse and neglect of Medicare recipients residing in SNFs and the associated oversight role of CMS.

In an “Early Alert” memorandum announcing the results of the audit, the Inspector General concluded that (1) a significant percentage of abuse and neglect incidents are not being reported and (2) the CMS lacks sufficient procedures to ensure that incidents are identified and reported. 

Under federal law, federally funded long-term care facilities must immediately report any reasonable suspicion of a crime committed against a resident.  The reports must be submitted to law enforcement authorities and to the CMS-designated State Survey Agency.  “Immediately” means within two hours if the incident caused serious bodily injury and within 24 hours if it did not.  (While it is beyond the scope of this article, nursing facilities have been under a November 28, 2017 deadline to implement policies and procedures for reporting crimes, pursuant to a Final Rule to revise Medicare and Medicaid participation requirements for nursing facilities that CMS published on October 4, 2016.)

According to the memorandum, the Inspector General identified 134 Medicare recipients who received emergency room care for injuries from abuse and neglect at SNFs from January 1, 2015 through December 31, 2016.  The audit also found that 28% of these incidents were not reported to law enforcement, in violation of the law. 

CMS is responsible for oversight and compliance with Medicare health and safety standards.  CMS delegates a variety of these tasks to the State Survey Agencies.  The Inspector General determined that CMS procedures are not adequate to ensure that abuse and neglect of Medicare recipients in SNFs are identified and reported.  The Inspector General recommended to CMS that it change its procedures to provide better protection of Medicare beneficiaries, including implementing regulations to impose penalties for violations of the reporting requirements and to direct State Survey Agencies to report violations of reporting requirements to CMS.

CMS will likely take action in response to the memorandum and SNFs will likely eventually feel the fallout.  Facilities should make sure they are compliant and maintain compliance with all current and impending crime reporting regulations.  The Inspector General’s memorandum may be accessed through this link:  https://oig.hhs.gov/oas/reports/region1/11700504.pdf

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