How a citation appeals process allows nursing home incidents to stay private

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Citations issued to nursing homes, even those for serious offenses, can be appealed to a special federal court in an informal dispute resolution process, which operates "almost entirely in secret," according to a New York Times investigation published Dec. 9.

Procedures for the process vary by state. The intended timeline for the process is 60 days, but The Times found it can sometimes take more than a year. CMS Chief Operating Officer Jonathan Blum told The Times that facilities are required to fix any issues regardless of whether they issued an appeal.

Inspectors’ findings are not posted on Care Compare, the Medicare website, when the review is underway. Even when citations are upheld, they aren't always published.

If an appeal is granted, the citation is often made less severe or deleted from the record altogether. 

The Times determined appeals are granted around 37 percent of the time through data provided from public health agencies across the country. Multiple states declined to provide the data, with Missouri and Florida officials saying they had been advised not to by CMS. The federal agency declined to disclose nationwide figures to The Times.

Mr. Blum told The Times citations are omitted during state-level appeals to be fair to nursing homes that are able to dispute claims. But, Mr. Blum also acknowledged the failure for every citation to appear on Care Compare and said CMS is working to correct the issue.


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