OIG Report Critical of AHCA’s Nursing Home Violation Verifications

Nursing home violationsFlorida’s Agency for Health Care Administration (AHCA) is under fire for failing to ensure that nursing homes followed through and properly corrected deficiencies for which they were cited in 2015.

A recently released report from the U.S. Department of Health and Human Services Office of the Inspector General (OIG) reviewed 100 deficiencies at nursing homes across the state. Of those, the OIG found 82 were corrected. Based on those findings from the sampling of data, the OIG estimated that AHCA did not obtain the nursing homes’ evidence of correction for 455 of 2,381 deficiencies.

The OIG determined that AHCA’s practice was to “accept the nursing homes’ correction plans as confirmation of substantial compliance, without obtaining the required evidence of correction for less serious deficiencies.”

AHCA must conduct standard surveys to determine whether nursing homes are in compliance with federal participation requirements using procedures spelled out in an operations manual to determine the quality of care being provided. Those surveys must be conducted at least once every 15 months.

Should there be any deficiencies, federal regulations require nursing homes that accept Medicare and Medicaid patients to submit corrective action plans to the Centers for Medicare and Medicaid Services or to the proper state agency. An acceptable correction plan must specify exactly how the nursing home corrected, or plans to correct, any deficiencies. Those corrected deficiencies must be verified either by obtaining evidence or from onsite reviews.

In its report, the OIG made two recommendations:

  • AHCA needs to improve its practices for verifying nursing homes’ correction of identified deficiencies by obtaining nursing homes’ evidence of correction for less serious deficiencies.
  • Update information system controls to ensure that data is protected against unauthorized or unintended modification or loss.

AHCA disagreed with the OIG’s first recommendation and its interpretation of the state operations manual, although it did agree to require facility documentation evidencing correction of citations for desk review revisits.

The OIG wrote: “Despite its disagreement with our interpretation of the Manual’s requirements, the State agency will begin requiring documentation from nursing homes as evidence that the facility corrected those citations at a severity and scope of D or higher.”

In addition, ACHA stated it planned to conduct quarterly quality audits of desk reviews.

The agency agreed with the second recommendation, that some data was missing, but noted it was not AHCA’s fault because it was required to use the Center for Medicare and Medicaid’s database, which it indicated “may have lost data through no fault of an individual surveyor or office.”

The OIG noted that CMS has replaced the previous system with a new one, which is expected to provide added data reliability.

In addition, AHCA asked that the title of the report be modified because it misrepresents the agency’s findings.

The OIG stood by its findings and recommendations.

The Health Law Offices of Anthony C. Vitale can assist nursing homes with the development and implementation of a federal and/or state corrective action plan should they be cited for deficiencies. Contact us for additional information at 305-358-4500 or send us an email to info@vitalehealthlaw.com.

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