Medicaid and Medicare report reveals rampant and widespread abuse and neglect in US nursing homes

A new report by Medicare and Medicaid services reveals rampant and widespead abuse and neglect of the elderly in U.S. nursing homes. Among the findings: 1) Failure to contact law enforcement even when there is evidence of abuse and neglect; 2) 80% of cases involved rape or sexual assault. The U.S. Department of Health and Human Services’ Office of Inspector General conducted the audit, releasing its initial findings in August.A final report examining eight randomly selected states is expected next summer.”We’re suggesting to CMS they conduct periodic data matches, like we did, to identify potential cases of abuse and neglect,” said Dave Lamir, regional inspector general who worked the team of auditors who produced the report.

In 28 percent of suspected abuse and neglect cases nationally, law enforcement was not notified. Eighty percent of the cases involved an alleged rape or sexual assault. CMS has taken no enforcement actions nor assessed penalties for failing to report. Five potential cases were found in Pennsylvania.All the suspected cases – identified by comparing Medicare claims to emergency room records in 33 states – were referred to state Medicaid Fraud Control Units. In Pennsylvania, the unit is operated by the attorney general’s office.

Joe Grace, a spokesman for Attorney General Josh Shapiro, did not make the unit available for interview and he declined to answer questions about the five cases referred to Shapiro’s office.

Although tasked with investigating and prosecuting fraud, abuse and neglect, under Pennsylvania law, the attorney general does not have the authority to prosecute patient abuse cases. Grace said the attorney general supports legislation expanding their authority. The suspected abuse and neglect cases occurred from Jan. 1, 2015, through Dec. 31, 2016.

Inspector General Daniel R. Levinson concluded: “CMS has inadequate procedures to ensure that incidents of potential abuse or neglect of Medicare beneficiaries residing in (skilled nursing facilities) are identified and reported.” Nursing homes and health care providers are mandated reporters.

Jeffrey Newman represents whistleblowers.