California nursing homes found cheating the Medicare system: Study found that many inflate self-assessment reports

A new study concluded that many nursing homes in California may be inflating their own self-assessment to boost their scores in the Five-Star Quality Rating System. With a higher score, these nursing homes can charge their clients extra, and receive special status in Medicare for being a “trusted” facility. These results are disturbing to say the least, with many families now worried that they may have placed their loved one in a less-than-respectable nursing home.

The study was conducted by faculty from the Florida Atlantic University and the University of Connecticut. The goal of the study was to see if the actual scores of various nursing homes in California — the nation’s largest system — were indeed correct. The five-star rating used by Medicare is made up of three components: a base score from an objective, on-site inspection, another from information on staffing, and the last a self-reported score by facility members. The authors of the study decided to verify the information after noting that scores for many nursing facilities had become higher over the last few years.

Aside from realizing that many facilities were being over-indulgent in their own personal assessment, the team also found that there existed little to no correlation between self-reported scores and on-site inspections. In fact, at least six percent of nursing homes were observed to have inflated their own scores just for financial gain.

“We were able to empirically demonstrate that inflation does exist in the current system,” explained co-author Xu Han. “So many nursing homes have a five-star rating; they look like they’re luxury hotels, but it’s difficult to see through that and determine what kind of service they’re actually providing. In reality, many of them are not really providing five-star services.”

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Han, along with authors Niam Yaraghi and Ram Gopal, hope that their findings will help Medicare perform better audits in the future. This can be done by determining the likely inflators and identifying key predictors of inflation. The authors believe that by adjusting the five-star rating accordingly, patients and their families will get a clearer and far more accurate score of their desired facility.

Data collected was from 2009 to 2013; the first five years after the five-star rating was implemented in 2008. One thousand two hundred nursing homes in California were analyzed.

Choosing the right nursing home for your loved one

An official government booklet from Medicare lists four steps you must do before deciding on a nursing home for your loved one. These are listed below:

1. Survey nursing homes within your area — While it can be a good idea to transfer your loved one out of state, most medical doctors agree that your chosen nursing home should be relatively near you. This is for your loved one’s safety as well; in case of emergencies, physicians will know how to contact you.
2. Compare the nursing homes — There are a variety of resources open to you. Instead of trusting online reports (which we’ve seen can be easily manipulated), we’d recommend asking social workers or other families who are in the same situation. Personal accounts will be more reliable.
3. Visit the home — Personal visits let you see what the conditions are really like. This is also the perfect opportunity to talk to residents and staff. If you cannot visit the nursing home, find someone you trust who can do it for you. It would also be ideal if you bring your loved one so that he or she can see whether the home would suit his or her needs and sensibilities.
4. Always consider special needs — Make sure that your chosen nursing home meets all your needs. This includes visitation hours, hospital discharge plans (if ever), and even spiritual advisors (if necessary). Remember to always trust your instincts. This is an important decision; do not rush it.

After you’ve made your decision, remember to give the nursing home staff the complete medical history and current health status of your loved one.

You can read more stories about healthcare and Medicare at Health.news.

Sources include:

NewsWise.com

ScienceDaily.com

Medicare.gov^[PDF]