OIG Issues Early Alert – Potential Abuse or Neglect at Skilled Nursing Facilities

PUBLISHED: Aug 28, 2017
Relevant to: Long Term Care

The Office of Inspector General (OIG) has issued a memorandum alerting the Centers for Medicare & Medicaid Services (CMS) to the preliminary results of their ongoing review of potential abuse or neglect of Medicare beneficiaries in skilled nursing facilities (SNFs). This audit is part of the ongoing efforts of the OIG to detect and combat elder abuse. OIG are communicating these preliminary results because of the importance of detecting and combating elder abuse. Also, according to Government Auditing Standards, "early communication to those charged with governance or management may be important because of their relative significance and the urgency for corrective follow-up action."

Thus far in their audit, OIG has identified 134 Medicare beneficiaries whose injuries may have been the result of potential abuse or neglect that occurred from January 1, 2015, through December 31, 2016. They also found that a significant percentage of these incidents may not have been reported to law enforcement. As a result, OIG has determined that CMS has inadequate procedures to ensure that incidents of potential abuse or neglect of Medicare beneficiaries residing in SNFs are identified and reported. OIG’s Early Alert contains suggestions for immediate actions that CMS can take to ensure better protection of vulnerable beneficiaries, some of which include:

  • Implement procedures to compare Medicare claims for emergency room treatment with claims for SNF services to identify incidents of potential abuse or neglect of Medicare beneficiaries residing in SNFs and periodically provide the details of this information to Survey Agencies.
  • CMS should continue to work with the HHS Office of the Secretary to receive the delegation of authority to impose the civil monetary penalties and exclusion provisions of section 1150B of the Social Security Act which requires covered individuals in federally funded long-term care facilities to report immediately any reasonable suspicion of a crime committed against a resident of that facility.
  • After receiving the delegation of authority, CMS should enforce section 1150B.

What does this mean for long term care facilities? While OIG's recommendations are directed to CMS, individual facilities should take note that CMS will likely be looking more closely at how facilities monitor and report incidences of suspected/actual elder abuse. This is a great opportunity for organizations to review their elder abuse prevention and reporting policies and procedures.

Included with today’s notice are example policies related to reporting and responding to suspected/actual elder abuse.

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