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OIG Nursing Home Memo Makes Now A Critical Time to Ensure Proper Reporting of Suspected Abuse or Neglect

You likely have heard the publicity surrounding last week’s release of a memorandum from the Department of Health and Human Services Office of Inspector General (“OIG”) heavily criticizing CMS for failing to ensure that nursing homes are reporting suspected incidents of resident abuse or neglect.  While the memo will undoubtedly trigger much greater scrutiny by state survey agencies regarding reporting incidents of suspected abuse or neglect in general, I wanted to point out a specific area that will likely be subject to much greater focus.

The OIG’s conclusions are based upon a review of the medical records of 134 Medicare beneficiaries that contained at least one of 12 diagnosis codes that the OIG believes “explicitly indicate” the potential for abuse or neglect.  Almost half of those codes involve suspicion or allegation of sexual abuse or assault and 110 of the 134 resident records that were examined contained these codes.  It is an unfortunate fact that there are numerous cognitive, mental, and behavioral conditions from which many residents suffer that result in statements or allegations of imagined sexual abuse or neglect.  It is also an unfortunate fact that staff can become desensitized to such statements after several investigations have been conducted and the allegations found to be imagined.  When this happens, future investigations (and reporting) may become lax or not occur at all.  The OIG’s clear focus on reporting allegations of sexual abuse or neglect makes now a critical time for facility leadership to reiterate the importance of investigating and reporting EVERY allegation of abuse or neglect regardless of the resident’s cognitive, mental, or behavioral condition or prior history of imagined allegations.  All facility staff, contractors and volunteers should already be trained to the facility’s policies and procedures for recognizing, investigating, reporting, and preventing abuse and neglect, but now is a perfect opportunity to reinforce the importance of complying with them.

About the Author

Ryan is the Co-Chair of the Health Care Practice Group at DeWitt.  He specializes in advising health industry clients in health law, regulatory compliance and risk management, legislative affairs, and insurance and ERISA litigation.  

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