June report on incidents from Office of Inspector General


By Kay Kaylor
Special to The SUN
As the part-time long-term care ombudsman for Archuleta County, I advocate for residents at Pine Ridge, a 24-hour extended care home, and BeeHive, an assisted living residence. Federal and state laws protect residents to promote quality of care and quality of life.
Readers who have friends or relatives in nursing homes throughout the United States might want to know about a June report published by the Department of Health and Human Services (HHS) Office of Inspector General (OIG). For an audit of HHS programs, the OIG reviewed almost 38,000 emergency room claims from Medicare beneficiaries who resided at skilled nursing facilities in 2016.
According to National Consumer Voice, the report “shows a disturbingly high level of potential abuse and neglect in skilled nursing facilities, and failures at every level of the system designed to protect vulnerable nursing home residents.”
A summary of the report, “Incidents of Potential Abuse and Neglect at Skilled Nursing Facilities Were Not Always Reported and Investigated,” is available to the public atoig.hhs.gov/oas/reports/region1/11600509.asp, with links to the full report or a brief version.
The OIG found that one in five high-risk hospital emergency room Medicare claims were the result of potential abuse or neglect, including injury of an unknown source, of residents in a skilled nursing facility. In addition, 42 nursing homes failed to report 84 percent of these claims to state survey agencies, as required by federal law. Five state survey agencies covering 34 facilities failed to report 67 of 69 claims of substantiated abuse to local law enforcement as required.
The Consumer Voice suggests several protective measures and states that the Centers for Medicare and Medicaid Services should impose significant monetary penalties for such failures.
For further information, please call me at 403-2164 or send an email to ombudsman2@sjbaaa.org.