A recently released report contained findings from an OIG audit that indicated the State of New Jersey did not ensure that nursing facilities always investigated and reported incidents of potential abuse or neglect involving Medicaid beneficiaries residing in nursing facilities to the State Agency in accordance with applicable Federal and State requirements.
Based on the results of the audit’s sample of 103 claims, an estimated 311 Medicaid hospital claims with selected diagnosis codes resulted from incidents of potential abuse or neglect at nursing facilities in New Jersey during CY 2016. Of this amount, an estimated 220 claims were the result of potential abuse or neglect that the nursing facilities did not investigate and report to the State. In addition, it was estimated that for 616 claims, the associated beneficiary’s nursing facility did not have records to sufficiently document the circumstances of the beneficiary’s injuries or condition that led to the hospital transfer so that State officials could determine whether the incident was the result of potential abuse or neglect.
According to the OIG, deficiencies noted in their audit sample occurred because nursing facility staff did not follow requirements for investigating and reporting potential incidents of abuse or neglect. In addition, the OIG identified that the New Jersey State Agency did not have adequate survey procedures for ensuring that nursing facilities documented all such incidents.
Recommendations from the report advise New Jersey officials to take the following steps:
- Reinforce guidance to nursing facilities to ensure that potential incidents of abuse or neglect are reported in accordance with Federal and State requirements; and
- Develop additional procedures for survey site visits, including reviewing nursing facilities’ records related to hospital transfers for certain beneficiary injuries or conditions that could be the result of potential abuse or neglect.
In the written comments of the draft report, it was noted that New Jersey officials did not indicate concurrence or nonconcurrence with the recommendations; however, they concurred with the audit’s findings.
Compliance Perspective
Failure to ensure that potential incidents of abuse or neglect are investigated, documented, and reported in accordance with state and federal requirements may result in OIG audits, deficiency citations, fines, and be considered violations of residents’ rights as indicated in F600, F607, F610, F686, and F689.
Discussion Points:
· Review policies and procedures regarding development of protocols for preventing abuse and neglect and requirements for investigating and reporting potential incidents of abuse and neglect.
· Train staff regarding prevention of abuse and neglect and how to document and when to report all incidents to their supervisor, to the state agency, or through the facility’s Hotline.
· Periodically audit to ensure that incidents of potential abuse and neglect are being investigated, documented, reported, and submitted to the proper authorities for investigation and follow-up.
