For the audit, HHS’ Office of Inspector General reviewed a sample of 104 hospital claims for ER visits in 2016. The claims were for Medicaid nursing home residents whose medical diagnosis codes indicated potential abuse or neglect. In this sample, auditors reviewed whether the nursing homes and Florida properly documented allegations or incidents of possible abuse or neglect.
The March 4 report couldn’t determine if Florida complied with federal requirements for surveying for and documenting possible abuse or neglect for Medicaid nursing home residents transferred to ERs. The report also found Florida didn’t have written policies and procedures for processing incident reports or have adequate intake staffing.
The watchdog agency recommended that Florida work with CMS to provide guidance to nursing homes about what constitutes a reportable incident and establish policies for incident reporting. Florida said it is working on addressing some of its processes and hiring additional staff.
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