OIG audit: Abuse in nursing homes often goes unreported to police, despite federal law

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About 28% of possible abuse cases in nursing homes go unreported to police, according to a federal audit.

More than a quarter of possible abuse cases in nursing homes go unreported to police, according to a federal audit that suggests Medicare is at fault for failing to enforce reporting requirements.

The U.S. Department of Health & Human Services Office of Inspector General issued an early alert as the audit continues, including investigation results from 33 states. The results were issued early, according to OIG, as the findings (PDF) were alarming enough to warrant immediate attention.

Federal law requires that nursing homes report potential incidents of abuse to law enforcement within two hours if there is a case of serious injury, or within a day otherwise. Civil monetary fines could reach $300,000 for skilled nursing facilities that fail to comply.

Illinois had the highest number of abuse cases identified in the report, with 17. In 28% of cases, the investigators could find no evidence in records to suggest that nursing facility staff had reported the incident to police, though federal law requires it.

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In one case cited in the report, an elderly nursing home resident who had mobility and verbal limitations was taken to the emergency room after an alleged sexual assault by a male resident.

But nursing home staff bathed her and changed her clothes after the incident, potentially eliminating evidence that would be needed for a rape kit, and did not report the alleged attack to police. The woman’s family was notified the next day, and they contacted law enforcement instead, according to the OIG.

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The results suggest that the Centers for Medicare & Medicaid Services have inadequate procedures to make sure potential abuse cases are identified and appropriately reported. CMS has not taken any enforcement actions on the reporting laws since they went into effect in 2011, according to the OIG.

CMS said it did not enforce the regulation because the HHS secretary had not authorized it to, according to the report. The OIG offered several steps CMS should take to better protect nursing home patients, including authorization for enforcement. The agency must also take steps to compare data and better identify possible cases of abuse.

Once it can enforce reporting requirements, CMS must strive to adjust regulations as needed and make sure its State Operations Manual is up to date with the requirements. The OIG said it will offer further recommendations when the audit is fully complete.