Audit Finds 134 Cases of Medicare Beneficiaries Who Were Abused or Neglected

Cases of alleged rape, sexual and physical abuse, neglect, maltreatment, and sadism cited

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September 5, 2017

There were 134 Medicare beneficiaries who were found with injuries that were the result of possible abuse dating back to 2015, according to an audit from the office of inspector general of the Department of Health and Human Services.

The inspector general created the memorandum to alert the agency that abuse and neglect was affecting beneficiaries in skilled nursing facilities. Under the Social Security Act, when a beneficiary living in a long-term care facility is exposed to abuse or neglect, the incident is required to be reported to a law enforcement agency so it can be investigated.

The audit found there were 134 cases from Jan. 1, 2015, to Dec. 31, 2016, where there was a beneficiary found with an injury due to abuse or neglect, and a large percentage of these were not reported.

According to the report, included in the 134 incidents were cases of alleged rape, seduction, sexual abuse, physical abuse, neglect, abandonment, maltreatment, and sadism. For example, one Medicare beneficiary who had verbal and mobile limitations was found victim to sexual assault.

"According to the emergency room record, a male resident of the [skilled nursing facility] allegedly sexually assaulted Ms. Doe," the audit states. "Nursing aides found the man on top of Ms. Doe squeezing and touching her breast and ejaculating on her. The emergency room record further noted that Ms. Doe's right breast was an "area of discomfort," and "two silver-dollar-sized bruises were observed on her breast."

The audit finds that this incident was not immediately reported to law enforcement. Instead, employees at the facility told the patient's family, and the family had to report the incident.

Auditors said the agency does not have proper procedures in place to ensure these cases are reported and identified. Additionally, this is not the first time the inspector general has seen problems with quality of care and neglect and abuse.

The Office of Inspector General "has issued numerous reports that have detailed problems with the quality of care and the reporting and investigation of potential abuse or neglect at group homes, nursing homes and [skilled nursing facilities]," the report states. "For example, OIG's recent audit reports on critical incident reporting at group homes showed that group home providers did not report up to 15 percent of critical incidents to the appropriate State agencies."

An estimated 22 percent of beneficiaries have been through adverse effects at skilled nursing facilities that include medication-induced bleeding, ulcers, and infections. A majority of these events—69 percent—could have been prevented.

Auditors are suggesting the agency take immediate action to ensure these incidents are immediately reported.

"The information in this alert is preliminary, and our audit is continuing," the auditors said. "We will issue a draft report at the conclusion of the audit and include the Centers for Medicare and Medicaid Service's comments and actions taken in response to this Early Alert."

Published under: Medicare