The Office of the Inspector General (OIG) issued an “early alert” to the Centers for Medicare & Medicaid Services (CMS) on August 24, 2017. The memo provides results of the OIG’s ongoing review of potential abuse or neglect of Medicare beneficiaries in skilled nursing facilities (SNFs), with the finding that CMS does not have adequate procedures in place to ensure that potential abuse or neglect incidents at SNFs are identified and reported in accordance with requirements. Findings from the memo include:
- OIG identified 134 Medicare beneficiaries who may have been abused or neglected in 33 different states by reviewing emergency room records for Medicare beneficiaries that included 12 primary diagnosis codes that “explicitly indicate potential abuse or neglect,” and publicly available Survey Agency reports for each SNF.
- OIG found 48 beneficiaries who were treated in the ER with diagnosis “Observation following alleged rape or seduction,” 32 beneficiaries with diagnosis “Encounter for examination and observation following alleged adult rape,” and 28 with the diagnosis “Adult sexual abuse, suspected, initial encounter.” An additional 9 diagnosis codes accounted for the rest of the identified issues, stemming from “Adult Physical Abuse” to “Adult neglect or abandonment, confirmed, initial encounter.”
- 74% of the reviewed medical records contained indications that the beneficiaries’ injuries may have been caused by potential neglect or abuse. These records included victim or witness statements and photographs that led to this finding.
- While 72% of hospital records reviewed were reported to law enforcement, the OIG was unable to determine if the remaining 28% had been reported as per requirements.
One of the key findings is that CMS has not taken any enforcement actions using section 1150B of the Act to ensure SNF employees report incidents of abuse or neglect. Although this was effective March 23, 2011, CMS did not update the State Operations Manual (SOM) to include the regulations for section 1150B related to covered individuals mandatory reporting of incidents until March 2017. The effective date for these requirements is at the beginning of Phase 2, November 28, 2017.
OIG made the following recommendations to CMS, with more to come in their final report:
- Implement procedures to compare Medicare claims for ER treatment with claims for SNF services in order to identify incidents of potential abuse or neglect
- Provide periodic reporting on the findings of the comparison analysis to Survey Agencies
- Work to receive delegation of authority to impose CMPs and exclusion provisions of section 1150 from HHS, which CMS officials have stated they are currently working to receive and that is why no actions have been taken yet.
Read the full memo, “Early Alert: The Centers for Medicare & Medicaid Services Has Inadequate Procedures to Ensure That Incidents of Potential Abuse or Neglect at Skilled Nursing Facilities Are Identified and Reported in Accordance With Applicable Requirements” (A-01-17-00504) on the OIG website.