The Office of the Inspector General (OIG) issued an Early Alert in late August following disturbing reports of abuse against Medicare Beneficiaries during stays in Skilled Nursing Facilities (SNFs). The Alert explained that an estimated 22 percent of Medicare beneficiaries experienced adverse events while at an SNF and 69 percent of these incidents could have been prevented with better care.

Elder abuse can take many forms, including sexual assault, pressure ulcers, medication-induced bleeding and infections. According to OIG, more than half of the Medicare beneficiaries experiencing an adverse event required hospital care for treatment.

OIG also found that a significant number of instances involving abuse or neglect may not have been reported to law enforcement. SNFs are required to ensure that the administrator of the facility receives reports of abuse, investigate the allegations, and report the results to the administrator within 5 days. Local hospitals are also required to report potential incidents of abuse or neglect. Notwithstanding these requirements, OIG found 38 out of 134 incidents (28 percent) where there were no evidence in hospital records that the incident was reported to local law enforcement.

OIG also declared CMS procedures inadequate to ensure incidents are reported. Section 1150B of the Social Security Act provides that certain individuals in federally funded long-term care facilities must report immediately any reasonable suspicion of a crime against a resident of the facility. The failure to report an incident can bring civil monetary penalties of up to $300,000 and possible exclusion from Federal health care programs. But Centers for Medicare and Medicaid Services (CMS) has not been enforcing this law, which became effective on March 23, 2011.

There are a few potential legal remedies for victims. For those who are seriously injured, a personal injury lawsuit to seek compensation is a possibility. This is an option where there is negligence or a deviation from the standard of care on the part of the medical professionals.

For employees or residents of facilities consistently providing inadequate care to Medicare and Medicaid patients, reporting through the False Claims Act is also an option. The False Claims Act allows for an individual to bring a lawsuit on behalf of the United States seeking return of money spent by the Government due to fraud. The government is paying a fee for the care of these individuals and when that care falls below the government’s expectation of care, it can be a violation of the law.

If you are aware of an skilled nursing facility providing inadequate care or a family member has been a victim of elder abuse, please call the attorneys of McEldrew Young Purtell Merritt at 1-800-590-4116 for a confidential consultation.