The federal government has regulations in place that require nursing facilities to report cases of possible abuse and neglect of Medicare patients. Nursing home facilities all over the country are ignoring these regulations and thousands of serious cases have never been reported.

Examination of Reporting Records

An intensive review of Medicare billing records was done by auditors from the inspector general’s office of the U.S. Department of Health and Human Services. Special focus was given to instances where a nursing home patient required a transfer from the care facility straight to an emergency room. Their findings revealed that approximately 6,600 cases in 2016 showed potential abuse or neglect of patients that were never reported. Of the total 37,600 instances where a Medicare recipient required transport from a nursing facility to a hospital emergency room, a red flag was raised for the auditors in approximately 18 percent of the cases. Gloria Jarmon, head of the audit division, declared, “Mandatory reporting is not always happening, and beneficiaries deserve to be better protected.”

Improving Oversight of Nursing Home Negligence

The Associated Press received a copy of the report compiled by the inspector general’s office. In response to the report, the administrator for the Centers for Medicare and Medicaid Services, Seema Verma, stated that they do not tolerate mistreatment and abuse and will exact sizeable fines on nursing home facilities that do not report such cases. According to Verma, the CMS agency is already working to create better supervision of nursing homes in crucial areas such as care units for dementia patients.

Agreeing with the recommendations of the inspector general, CMS has formally agreed to increase oversight by:

• Supplying clearer instruction to nursing facilities about the type of episodes that must be reported
• Enhancing training for care center staff
• Requiring state inspectors to record and track potential cases
• Monitoring all instances reported to law enforcement agencies

Why is Abuse Unreported?

It can be difficult to expose cases of abuse or neglect of elderly patients, according to investigators, because vulnerable elderly victims are often afraid to tell anyone, even close friends or relatives. Therefore, it is not very likely they will tell authorities either.

As an example of how abuse and neglect can be camouflaged by medical conditions, the report gives the example of a woman, age 65, who was transported to a hospital emergency room in critical condition. Struggling to breathe and suffering kidney failure and delirium, she was found to be the victim of opioid poisoning due to an error in nursing care. Further details in the report show that a nurse had incorrectly copied a doctor’s orders, resulting in the patient receiving larger doses of pain medication than she should have been given. After treatment at the hospital, the patient was taken back to the same care facility where the errant nurse was given remedial training. The tragedy was never reported to authorities as required. According to the inspector general’s report, this is a perfect example of neglect that the nursing facility should have reported.

The facilities that were examined in the inspector general’s report are ones that provide therapy services and skilled nursing to Medicare patients who’ve had surgery or other hospitalizations. Some of the facilities combine long-term, nursing home care with a rehabilitation wing.

It was extremely challenging for investigators to uncover the full degree of unreported cases since there is no database to access and input a request for items that have never been reported. Some facilities even attempt to hide nursing home abuse. Cases that are not reported are virtually invisible. As a result, auditors had to create a listing of Medicare billing codes that had previously been linked in other investigations to potential abuse and neglect. Included were red-flag items such as head injuries, fractures, gangrene, shock, and foreign objects swallowed. Auditors pulled samples and requested that state inspectors point out which cases should have been reported. It became clear that nursing home staff and state inspectors had an inconsistent and unclear understanding of reporting requirements. Medicare offered clarification, without challenging the estimates, by explaining that a billing data time lag may make it difficult to spot problems in real-time.

Also flagged in the report are problems where documented cases of neglect or abuse are not reported by state nursing home inspectors to local law enforcement, as required. Federal auditors looked at 69 cases across a five-state region where verified abuse or neglect had occurred in nursing home facilities. Shockingly, only two of those cases were reported to law enforcement.

In one of the cases, a male resident was seated in the dining room of the facility when a nursing home employee passed by and pushed the back of the resident’s head and continued walking. Even though the employee denied the abuse, the act was caught on surveillance video. State inspectors had verified that the abuse took place, according to the inspector general’s report, but they never reported the abuse to local law enforcement.   

Get Help From an Experienced Elder Abuse Lawyer

If your loved one has been the victim of nursing home negligence and abuse, contact KBA Attorneys. Our nursing home abuse lawyers have years of combined experience in handling nursing home abuse claims. Let our professional legal team help your family find justice and compensation for the harm that was caused. 

References

The Associated Press. “Watchdog: Neglect and Abuse Unreported in Nursing Facilities”, U.S. News & World Report, https://www.usnews.com/news/business/articles/2019-06-12/watchdog-neglect-and-abuse-unreported-in-nursing-facilities. Accessed August 11, 2019.