OIG Audit Finds California Has Failed To Protect Nursing Facility Residents



The Allegiant Experts team is saddened and disappointed to learn of the findings from a recent audit from the Office of Inspector General. As they reported a week ago, the audit found that the state of California did not ensure that nursing facilities always reported incidents of potential abuse and neglect. The audit examined the treatment of our elderly and vulnerable living in nursing homes. The findings are shameful.


As the report notes, nursing facility residents are at an increased risk of abuse or neglect when health care professionals and caregivers fail to report incidents of potential abuse or neglect. These elderly residents are also put at further risk of harm when allegations of abuse or neglect are not acted upon in a timely manner.


The objectives of the OIG audit were twofold.


Firstly, they wished to determine whether or not California ensured that nursing facilities reported incidents of potential abuse or neglect of Medicaid beneficiaries. Specifically, they looked at when these individuals were being transferred from nursing facilities to hospital emergency departments.


Secondly, the audit looked into whether or not California complied with Federal requirements for recording, prioritizing and investigating allegations of abuse or neglect. To make these discoveries, the OIG audit covered 4,965 claims. The claims were made between July and December 2017 by Medicaid beneficiaries who resided in California nursing facilities and were transferred to hospital emergency departments.


The OIG audit findings were alarming.


California did not ensure that nursing facilities always reported incidents of potential abuse or neglect of Medicaid beneficiaries transferred from nursing facilities to hospital emergency departments.


“Of the 118 sampled incidents reviewed, 81 were not the result of potential abuse or neglect; therefore, nursing facilities were not required to report the incidents to the State,” reports OIG, “However, of the remaining 37 incidents, 8 incidents were the result of potential abuse or neglect and should have been reported to the State: 2 were reported in a timely manner, 4 were not reported in a timely manner, and 2 were not reported to the State by the nursing facilities.”


OIG also reports that California did issue guidance to nursing facilities on the proper reporting of potential abuse or neglect. However, facilities did not always report incidents or report them in a timely manner. “For the other 29 incidents, nursing facilities provided documentation that did not contain sufficient information to determine whether the incidents were the result of potential abuse or neglect,” details the report, “therefore, the State was unable to determine whether the requirements for reporting potential abuse or neglect were met.”


OIG made two strong recommendations to California.


Firstly, the state must strengthen guidance to nursing facilities on reporting incidents of potential abuse or neglect of Medicaid beneficiaries. Secondly, California must ensure that nursing facility staff members are regularly trained on updated Federal and State requirements. This is to ensure that appropriate priorities are assigned to allegations of abuse or neglect.


At Allegiant Experts, everything we do focuses on inclusive, comprehensive and cost-effective health care. We coordinate and support courageous whistleblowers who shine a light on fraud, waste and abuse. Can we be of service to you? To learn more about how we can help you or to schedule a complimentary consultation, please don’t hesitate to call us at 407-217-5831 or email us at info@allegiantexperts.com.

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