Elder abuse of Medicare beneficiaries at nursing homes is being underreported to law enforcement, and the Centers for Medicare & Medicaid Services “has inadequate procedures” to ensure facilities are complying with the law, according to an early alert issued Monday by the Health and Human Services Inspector General’s office.

The preliminary results of the Inspector General’s ongoing review identified 134 Medicare beneficiaries whose injuries may have been the result of potential abuse or neglect occurring during 2015 and 2016. In addition, “a significant percentage” — 28 percent — of these incidents may not have been reported to law enforcement.

The Inspector General found no evidence in the hospital records that the 38 incidents were reported to local law enforcement, despite mandatory state reporting laws requiring the hospitals’ medical staff to do so. Moreover, prior audit reports show that group homes did not report up to 15 percent of critical incidents to the appropriate state agencies.

“Our preliminary results combined with these prior report results raise significant concerns that incidents of potential abuse or neglect at skilled nursing facilities have gone unreported,” wrote Inspector General Daniel R. Levinson, in his alert addressed to CMS Administrator Seema Verma.

The alert cites specific cases, including one in which a male resident of a nursing facility allegedly sexually assaulted a female Medicare beneficiary, leaving “two silver-dollar-sized bruises” on her breast, according to emergency room records. The facility’s employees did not immediately report the incident to law enforcement, but told her family the next day, who contacted police, according to the report submitted by the states survey agency overseeing the facility.

“The emergency room record notes that the skilled nursing facility staff assisted Ms. Doe with bathing, going to the bathroom, and changing her clothing after the incident,” Levinson writes. “These actions could have destroyed any evidence that may have been detected using the rape kit.”

A facility staff person later contacted local law enforcement in an attempt to keep the police from investigating the incident, according to the survey agency’s report. The staffer told the police that the facility was “required to report it, but that we were doing our own internal investigation and did not need them to make a site visit.” Furthermore, “no one was interested in pressing charges and that we were handling.” However, the police continued an investigation despite this contact, according to the agency’s report.

The Inspector General’s alert suggests that CMS take a number of immediate actions to ensure abuse in nursing facilities is reported, including implementing procedures to compare Medicare claims for emergency room treatment with claims for facility services to identify incidents, and then periodically provide the details of this analysis to state survey agencies for further review.

The CMS should also continue to work to obtain authority from HSS to impose civil monetary penalties on such facilities, according to the alert.

Curtis Roy, an assistant regional inspector general in the Department of Health and Human Services, told NPR’s Morning Edition that “we've got to do a better job of getting [abuse] out of our health care system.”

The Inspector General is now trying to determine whether the nursing homes where abuses took place were ever fined or punished in any way, and will detail its results in its full report, expected in about a year, Roy tells NPR.

“We hope that we can stop this from happening to anybody else,” Roy told the Associated Press, noting that quality is an ongoing concern for the roughly1.4 million people who live in U.S. nursing homes.

Instant Insights /

Elder abuse in nursing homes underreported: HHS Inspector General

More From HR Executive

Related Stories

Recommended For You