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Congress Raises Concerns of Inadequate Patient Protection in Skilled Nursing Facilities

The House of Representatives Committee on Energy and Commerce (the Committee) sent a letter to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma requesting that CMS provide documents relating to issues of abuse and neglect at skilled nursing facilities (SNFs) and nursing facilities (NFs) across the country. The letter specifically referenced recent media reports of significant abuse and neglect at these facilities, including the incident at Hollywood Hills Rehabilitation Center in Florida where 14 NF residents died in the aftermath of Hurricane Irma. Committee members stated that the media reports, “raise serious questions about the degree to which [CMS] is fulfilling its responsibility to ensure federal quality of care standards are being met, as well as its duty to protect vulnerable seniors from elder abuse and harm in facilities participating in the Medicare and Medicaid programs.” Related reports from the U.S. Government Accountability Office (GAO) and the Department of Health and Human Services (HHS) Office of Inspector General (OIG) deepened the Committee’s concerns.

The Committee letter cited an Early OIG Alert from 2017 that identified 134 Medicare beneficiaries receiving treatment at SNFs during calendar years 2015 and 2016 whose injuries may have been the result of potential abuse or neglect. A significant percentage of these incidents may not have been reported to law enforcement, according to the OIG’s findings. The OIG concluded that CMS procedures were inadequate to ensure that incidents of potential abuse or neglect of Medicare beneficiaries residing in SNFs were reported. The OIG alert also identified potential abuse and neglect of Medicare beneficiaries at NFs in 33 different states. Approximately 28 percent of those incidents had no evidence of being reported to local law enforcement, despite legal requirements. These findings, combined with prior reports, raised Committee members’ concerns that many SNF and NF abuse and neglect incidents may be going unreported.

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Based on these findings, the referenced OIG Alert called for CMS to:

  • Implement procedures to compare Medicare claims for emergency room treatment with claims for SNF services to identify incidents of potential abuse or neglect;
  • Periodically provide details of this analysis to the Survey Agencies for further review;
  • Continue working with HHS to receive enforcement authority to impose civil monetary penalties and the exclusion provision of Social Security Act Section 1150B; and,
  • Issue regulations that direct Survey Agencies to refer suspected violations to CMS for appropriate action.

In September of 2017, CMS indicated to the Committee that it was working with the HHS Office of the Secretary to speed up its receipt of authority to commence enforcement actions under Section 1150B.

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