Federal Investigation Finds 1 Out of 5 Cases of Nursing Home Abuse and Neglect Go Unreported

Nursing home abuse and neglect is a more widespread problem in Ohio than you might realize. One reason this issue does not get the public attention it deserves is that many cases of abuse and neglect simply go unreported by nursing homes, even though federal law requires them to do so.
To that end, the Office of Inspector General (OIG) at the U.S. Department of Health and Human Services recently released an audit report that examined approximately 37,000 “high-risk hospital” emergency room claims involving Medicare beneficiaries living in nursing homes during 2016. This audit found that roughly 1 out of 5 claims “were the result of potential abuse or neglect.” And in many cases, nursing homes simply did not report the potential abuse and neglect.
The 1-in-5 figure was based on a random sample of 256 cases taken from 8 states. (The OIG did not specify which states it used.) Out of these 256 high-risk ER claims, the OIG said “51 were the result of incidents of potential abuse or neglect” that should have been reported under federal Medicare rules. Yet 43 of them were not.
The OIG further broke down the 51 cases of potential abuse or neglect as follows:

  • 26 involved some type of head injury, including 4 cases of “traumatic brain injury”;
  • 16 involved bodily injuries: 12 femur fractures, 2 vertebra fractures, and 1 should dislocation;
  • 6 involved “safety issues,” primarily poisoning incidents due to the “over-administration” of drugs;
  • 3 involved “medical issues,” including aspiration pneumonia and sepsis.

As a “representative example” of one of the 51 cases, the OIG said a 72-year-old Medicare beneficiary was diagnosed at the ER with aspiration pneumonia. The beneficiary’s wife “expressed concerns” regarding her husband’s care at his nursing home. She pointed to a number of specific failures on the part of the nursing home’s staff.

OIG: Medicare Not Providing Sufficient Guidance on Reporting Obligations

The 43 unreported cases of potential abuse and neglect involved 42 separate nursing homes. The OIG said it asked each of the 42 homes to explain why they did not report the incidents identified by the audit. Only 35 nursing homes replied, and “in general,” the OIG said their excuse was that “they did not believe the incidents met Federal reporting requirements.”
From this, the OIG concluded that Medicare’s own guidance for reporting incidents of potential abuse and neglect were “not clear,” leading to “inconsistent” interpretations on the part of individual nursing homes. The OIG advised Medicare to “improve training” for nursing home staff on this subject and to “clarify guidance to clearly define and provide examples of incidents of potential abuse or neglect.”

Contact the Cleveland Nursing Home Abuse & Neglect Lawyers at Tittle & Perlmuter Today

One takeaway from OIG’s report is that family members should not hesitate to speak up if they feel their loved one is suffering from abuse or neglect. Do not assume the nursing home will take action on its own. And if you have additional questions or concerns, consult an experienced Cleveland nursing home abuse and neglect attorney. Contact Tittle & Perlmutter at (216) 308-1522 if you need to speak with a lawyer today.

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