Compliance Perspective:
The compliance officer shall commence an investigation as soon as reasonably possible after an incident has occurred, bearing in mind laws requiring notification within specified time periods, e.g., notification to local law enforcement authorities within a 2-hour timeframe where a crime is suspected.
The inspector general’s office of the Health and Human Services Department (HHSD) issued what it called an “early alert” this week about the large percentage of sexual and physical abuse incidents occurring in nursing homes, but not being reported to police in compliance with federal law. The alert is urging the Centers for Medicare & Medicaid Services (CMS) to begin immediately to correct this situation.
The report indicates that more than 25 percent of the alleged “sexual and physical abuse” cases they uncovered were not reported to local law enforcement authorities. Some of the
cases that were reported were not reported in a timely manner. The information was obtained through HHSD audits investigating “fraud, waste and abuse in the healthcare system.”
Nursing homes are required to report any incidents where a crime is involved within a 2-hour period if there is serious physical harm.
The HHSD is urging the CMS to use an approach similar to the one they used to identify possible instances of nursing home abuse. That audit procedure used involved searching computerized billing for indicative signs of abuse by connecting emergency room and nursing home records.
One of the cases that was classified as having been reported to the police involved a woman with verbal and limited mobility who was sexually assaulted by an employee of the nursing home. Unfortunately, the staff helped the woman bathe and change her clothing before taking her to the emergency room, and they did not immediately report the incident to the police. The evidence that would have been needed to prove such an assault was compromised.
