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Alabama Attorneys Discuss the Disturbing Trend of Abuse and Neglect of Medicare Beneficiaries

Alabama nursing home attorneyResidents across Alabama place a great deal of trust in nursing home facilities. Sometimes that trust is broken when residents are injured or become ill due to the negligent actions of staff members and administrators. What's worse, many incidents are never tracked, documented, or reported to law enforcement.

The Department of Health and Human Services Office of Inspector General (OIG) recently released two reports addressing potential abuse and neglect of the elderly and individuals with disabilities in nursing homes. Their findings are shocking.

The reports scrutinized the identification, reporting, and investigation of incidents involving nursing home abuse or neglect. The purpose of the audit was to determine the following:

  • Prevalence of abuse and neglect of Medicare beneficiaries living in skilled nursing home facilities (SNFs) with a 2016 hospital emergency room Medicare claim involving a high-risk diagnosis code.
  • Whether SNFs properly reported incidents of abuse or neglect.
  • Whether reported findings of abuse were reported to law enforcement by the Centers for Medicare & Medicaid Services (CMS) and State Survey Agencies.
  • The extent to which CMS requires recording and tracking of incidents.

Data from hospital ER claims

The audit covered approximately 37,607 high-risk hospital ER claims for 34,820 Medicare beneficiaries living in SNFs throughout 2016. Supporting documents were reviewed in approximately 256 high-risk hospital ER Medicare claims. Patients were treated for conditions such as:

  • Traumatic brain injuries
  • Broken legs
  • Shoulder dislocations
  • Medication errors

Through their findings, the OIG estimated that roughly one in five hospital ER Medicare claims during 2016 were attributed to potential abuse or neglect. Sadly, the findings concluded that many SNFs didn’t report incidents to the Survey Agencies in compliance with federal law. Among incidents that were reported, the Survey Agencies failed to report them to law enforcement. In addition, CMS was found to not require incidents reported to law enforcement and other agencies to be recorded and tracked.

Determining potential abuse or neglect through Medicare data

In another audit, OIG reviewed approximately 34,664 Medicare inpatient and outpatient claims between January 2015 and June 2017 involving up to 17 diagnosis codes related to abuse, neglect, or maltreatment.

An estimated 30,754 claims (90%) showed evidence of potential abuse or neglect, 2,574 of which were believed to be perpetrated by healthcare workers. In addition:

  • 3,330 were found to be related to incidents occurring in medical facilities
  • 9,294 were found to not be reported to law enforcement

CMS failed to identify Medicare claims relating to potential abuse or neglect because its data was not based on the 17 diagnosis codes. This lack of data creates legal and corrective hurdles when addressing patient safety.

If you suspect that an elderly or disabled person is a victim of abuse or neglect, it’s crucial that you bring it to the attention of law enforcement immediately. Not only should perpetrators be brought to justice, but other parties responsible for preventing or stopping incidents of abuse and neglect should be held accountable.

The attorneys at Shuttlesworth Law Firm LLC are dedicated to protecting the safety of seniors living in Alabama nursing homes and fighting for the rights of victims. Don't wait! Contact us today for a free case evaluation.

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