Unreported Cases of Elder Abuse in Nursing Homes Serious Problem for CMSInstances of abuse perpetrated on any member of a vulnerable population are invariably tragic, but when those cases are kept hidden from law enforcement, the potential tragedy widens. Approximately 1.4 million Americans live in skilled nursing facilities, many of them incapacitated in some way, and therefore especially vulnerable to potential abuse.

Although abuse of the elderly in nursing homes has been a grave issue in this country, an audit-in-progress reveals that even the threat of fines against the facilities isn’t solving the problem of unreported crimes against seniors.

Federal law requires potential abuse/neglect to be reported at once…

Since 2011, Medicare regulations have stipulated that any suspected abuse or neglect of elderly or disabled patients in nursing homes must be immediately reported to the authorities (within two hours of discovery if serious bodily injury has occurred, within 24 hours otherwise). The penalty for not reporting is a fine of up to $300,000.

And yet, an audit underway by the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) shows that skilled nursing facilities aren’t always reporting the incidents, and the Centers for Medicare & Medicaid Services (CMS) is not following through with levying the punitive charges.

Despite the fact that the audit of emergency room records encompassing the years 2015 and 2016 is not yet complete, the OIG felt the disturbing results gleaned so far warranted a warning to the public in the form of an “early alert” ahead of the investigation’s full findings.

The alert states: “During our review of skilled nursing facilities across the nation, we found 134 instances of potential abuse and neglect in 33 states. These potential cases involve failure to provide necessary medical care to patients, and even occurrences of physical abuse and sexual assault.”

California had the fourth highest number of potential cases of abuse or neglect (eight). Illinois topped the list with 17 cases of suspected elder abuse, followed by Michigan and Texas at 13 and 9.

…and yet, the law has not been enforced.

Twenty-eight percent of the ER episodes identified in the audit were apparently not reported to police (auditors could find no evidence that the nursing home had contacted the authorities). And among those cases, 80% of them involved possible sexual assault or rape.

And worse than spotty enforcement from the CMS is no enforcement at all, which is what the OIG reports.

Although the penalty for failing to report suspected neglect or abuse of the elderly in skilled nursing facilities has been in effect for nearly six years, the OIG says that the CMS has not flexed its enforcement muscle even once. The reason offered by the CMS? That the HHS had not explicitly given it the authorization to enforce the rule.

The OIG’s unequivocal, uncompromising stance on the issue is made clear in the early alert to the public: “These types of abuses and neglect cannot be tolerated. HHS OIG will continue reporting on the quality of care in skilled nursing facilities and other medical facilities that provide care to Medicare and Medicaid patients.”

OIG calls on the public to be alert to possible abuse or neglect

Further, the agency asks for help from the public: “We are also urging citizens to be vigilant; visit your loved ones often who are in these facilities, ask them if they are being treated properly, and report potential cases of abuse or neglect to your local police and your state’s Medicaid Fraud Control Unit.”

The OIG states that it plans to offer the CMS specific recommendations when the investigation has been completed, but for now it has warned the agency that it must enforce action for unreported cases of abuse or neglect. Additionally, the OIG instructed the CMS to actively and continually assess regulations, make revisions when needed, and update its State Operations Manual for accuracy and consistency.

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