A federal watchdog found that Florida didn’t make sure that nursing homes were reporting or looking into allegations of potential abuse or neglect of Medicaid beneficiaries.
After reviewing 104 hospital claims for 2016 emergency department visits of Medicaid nursing home residents, HHS’ Office of Inspector General found that nursing facilities failed to report at least 15 incidents associated with potential abuse or neglect because nursing facility officials and state officials “did not have the same understanding about what incidents must be reported,” according to the report. Another seven cases didn’t have enough information filed to determine if the incident should have been reported.
HHS OIG also found that the Florida Agency for Health Care Administration’s Division of Health Quality Assurance, which processes reports, didn’t have an effective incident report system. The system didn’t have written policies or procedures for processing reports and didn’t have enough intake staffing, which could have limited that state’s ability to look into potential abuse and neglect cases, the report found.
The Florida agency could not immediately be reached for comment.
In one case, a resident who fell and was having trouble breathing was sent to a hospital emergency department. X-rays showed evidence of previous rib fractures that had healed.
“The location of the broken ribs (5th, 8th, and 10th) was suspicious and indicative of being beaten, instead of a typical fall where sequential ribs (like 8th, 9th, and 10th) would have been broken,” the report said. The nursing home had not conducted an internal investigation.
HHS OIG recommended the state work with CMS to develop clear guidance to nursing homes on reportable incidents, create written policies and procedures for incident report processing and late reports and evaluate staffing levels, among other things.
In response to the report, the Florida Agency for Health Care Administration’s Division of Health Quality Assurance said not reporting potential cases of abuse or neglect was a failure of nursing homes, not the agency and that any confusion about reporting requirements was CMS’ responsibility. The agency also said it had improved its written policies and procedures about incident reporting.