Inspector general urges scouring of billing records for tell-tale signs of possible abuse
By Ricardo Alonso-Zaldivar
Associated Press
WASHINGTON (AP) - More than 1 in 4 cases of possible sexual and physical abuse against nursing home patients apparently went unreported to police, says a government audit that faults Medicare for failing to enforce a federal law requiring immediate notification.
The Health and Human Services inspector general's office issued an "early alert" Monday on preliminary findings from a large sampling of cases in 33 states. The results were sufficiently alarming that investigators say corrective action is needed now.
"We hope that we can stop this from happening to anybody else," said Curtis Roy, an audit manager with the inspector general's office, which investigates fraud, waste and abuse in the health care system. The audit is part of a larger ongoing probe, and additional findings are expected.
With some 1.4 million people living in U.S. nursing homes, quality is an ongoing concern. Despite greater awareness, egregious incidents still occur.
In a statement, Medicare emphasized that nursing home safety is a high priority, but said it will await a complete report before announcing a response. That didn't impress Sen. Charles Grassley, R-Iowa, who said he will push for Medicare to take immediate action.
"A crime is a crime wherever it takes place," Grassley said in a statement. "It's unacceptable for more than one-fourth of potential crimes in nursing homes to apparently go unreported."
Of the unreported cases, about 4 out of 5 involved alleged or suspected rape or sexual abuse.
The inspector general urged Medicare to systematically scour computerized billing records for tell-tale signs of possible abuse of nursing home residents. Investigators used that approach to find cases, matching hospital emergency room and nursing home records.
Auditors identified 134 cases in which emergency room records indicated possible sexual or physical abuse, or neglect. The incidents spanned a two-year period from 2015-2016.
Illinois had the largest number of incidents overall, with 17. It was followed by Michigan (13), Texas (9), and California (8).
In 38 of the total cases (28 percent), investigators could find no evidence in hospital records that the incident had been reported to local law enforcement, despite a federal law requiring prompt reporting by nursing homes, as well as similar state and local requirements.
"Based on the records we had available to us, we could not determine that they had been reported to law enforcement," said Roy.
The federal statute has been on the books more than five years, but investigators found that Medicare has not enforced its requirement to report incidents to police and other agencies, or risk fines of up to $300,000.
Nursing home personnel must immediately report incidents that involve a suspected crime, within a two-hour window if there's serious bodily injury. Otherwise, authorities must be notified within 24 hours.
Medicare "has inadequate procedures to ensure that incidents of potential abuse or neglect of Medicare beneficiaries residing in (nursing homes) are identified and reported," the inspector general's report said. Medicare responded it has long required immediate reporting, but to state inspectors.
Even among the 96 cases that were ultimately reported to police departments, investigators were unable to tell if the federal requirement for "immediate" notification was followed.
In one case classified as "reported to law enforcement," an elderly woman with verbal and mobility limitations was taken to the emergency room after she was allegedly sexually assaulted by a male resident of the same nursing home. The report said two silver-dollar-sized bruises were noted on her right breast.
Nursing home staff had helped the woman bathe and change clothes after the incident. "These actions could have destroyed any evidence that may have been detected using the rape kit," said the report.
Nursing home employees did not immediately report the incident to police, although the federal reporting requirement was in effect. The nursing home "should have reported the incident to law enforcement within two hours of witnessing the incident," the report said.
Instead, the following day the nursing home contacted the woman's family, who called the police, triggering an investigation.
Citing a separate probe by state officials, the inspector general's report said the nursing home "contacted local law enforcement in an attempt to keep law enforcement from investigating the incident."
The state's own report found that the nursing home told police "we were required to report it but that we were doing our own internal investigation and did not need (police) to make a site visit...no one was interested in pressing charges." The police continued their investigation.
The state later cited the nursing home for failing to immediately notify the patient's doctor and family, as well as other violations of federal regulations. But state inspectors classified the incident as resulting in "minimum harm or potential for actual harm."
No other details were provided in the federal report. The inspector general's office reported all 134 cases to local police.
The number of nursing home residents is expected to grow in coming years as more people live into their 80s and 90s. Medicaid is the main payer for long-term care, while Medicare covers doctors' services and hospital care for elderly people and the disabled.
Published: Wed, Aug 30, 2017
