On June 12, 2019, a report released by the Health and Human Services’ Office of the Inspector General revealed that Nursing Home Abuse remains largely unreported. The report estimates that one-in-five high-risk hospital emergency room Medicare claims for treatment provided during the 2016 calendar year were the result of potential abuse or neglect, including injury of unknown source, of beneficiaries residing in skilled nursing facilities (SNF).

The report also revealed that nursing homes are failing to comply with regulations established by the Centers for Medicare and Medicaid Services (CMS). Under these regulations, SNFs are required to report incidents of abuse and neglect to Survey Agencies, who are then required to report the incidents to the CMS or local enforcement agencies. However, both SNFs and Survey Agencies have been failing to meet their federal requirements. Currently, the CMS may not be doing all they can to prevent abuse as it does not require all potential incidents to be tracked in the Automated Survey Processing Environment Complaints/Incidents Tracking System.

The Office of Inspector General (“The Office”) is urging CMS to take action since “preventing, detecting, and combating elder abuse requires CMS, Survey Agencies, and SNFs to meet their responsibilities.”

The Office suggests that CMS work with Survey Agencies to train SNF staff on identifying and recording all potential incidences of abuse or neglect. They also suggest that CMS require Survey Agencies to record and track all incidents of potential abuse or neglect in SNFs, as well as all referrals made to local law enforcement and other agencies. CMS concurred with these recommendations and stated they are creating a plan to ensure more accurate reporting in the future.

This post features contributions from Bridget Velez.