OIG Early Alert: Improving CMS Procedures for Reporting Incidents of Potential Abuse or Neglect at SNFs

September 8, 2017 | Aging Services Risk Management


​Preliminary audit results from the U.S. Department of Health and Human Services' (HHS) Office of Inspector General (OIG) show inadequate Centers for Medicare and Medicaid Services (CMS) procedures for identifying and reporting incidents of resident abuse and neglect at skilled nursing facilities (SNFs). An OIG memo released August 24, 2017, asserts that SNFs “must ensure that all alleged violations, such as mistreatment, neglect, or abuse (including injuries of unknown source) and misappropriation of resident property, are reported immediately to the administrator of the facility and to other officials . . . in accordance with State law through established procedures. " If the incident is verified, the memo notes, the facility must take corrective action. The audit focused on 134 Medicare beneficiaries (with 135 emergency room reports) whose injuries suggested potential abuse or neglect, between January 2015 and December 2016, across 33 states. Of these cases, the authors write, 74% of the medical records contained indications of potential abuse or neglect. However, in 28% OIG could not find evidence that the incident had been reported to law enforcement, as required by state mandatory reporting laws for hospital staff. In addition, a prior audit found that up to 15% of “critical incidents" occurring in group homes were not reported to appropriate state agencies.

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