Florida Did Not Ensure That Nursing Facilities Always Reported Allegations of Potential Abuse or Neglect of Medicaid Beneficiaries and Did Not Always Assess, Prioritize, or Investigate Reported Incidents

Date Issued

Thursday, March 4, 2021

Submitting OIG

Department of Health & Human Services OIG

Other Participating OIGs

Department of Health & Human Services OIG

Agencies Reviewed/Investigated

Department of Health & Human Services

Report Number

A-04-17-08058

Report Description

This audit report is one of a series of OIG reports addressing the identification, reporting, and investigation of incidents of potential abuse or neglect of our Nation’s most vulnerable populations, including the elderly and individuals with developmental disabilities. Our objectives were to determine whether Florida: (1) ensured that nursing facilities reported potential abuse or neglect of Medicaid beneficiaries transferred from nursing facilities to hospital emergency departments; (2) complied with Federal requirements for assigning a priority level, initiating onsite surveys, and recording allegations of potential abuse and neglect; and (3) operated its incident report program effectively.

Report Type

Audit

Location

FL,
United States

Number of Recommendations

Questioned Costs

Funds for Better Use

Open Recommendations

This report has 7 open recommendations.

Recommendation Number	Significant Recommendation	Recommended Questioned Costs	Recommended Funds for Better Use
270243	No	$0	$0
1. We recommend that the Florida Agency for Health Care Administration, Division of Health Quality Assurance work with CMS to provide clear guidance to nursing facilities regarding what constitutes a reportable incident.
270244	No	$0	$0
We recommend that the Florida Agency for Health Care Administration, Division of Health Quality Assurance establish procedures that include documenting assessment start and end dates and priority level assignments.
270245	No	$0	$0
We recommend that the Florida Agency for Health Care Administration, Division of Health Quality Assurance establish and implement written policies and procedures for incident report processing.
270246	No	$0	$0
We recommend that the Florida Agency for Health Care Administration, Division of Health Quality Assurance evaluate its staffing levels to determine whether staffing is adequate.
270247	No	$0	$0
We recommend that the Florida Agency for Health Care Administration, Division of Health Quality Assurance improve the intake process by: (a) assessing all Federal 24-Hour Reports to identify whether potential noncompliance with quality of care standards caused the incidents and whether the incident occurred after the last standard survey; (b) assessing the severity and urgency of harm to the resident(s) that may have been caused by abuse, neglect, or nursing facility noncompliance with CoPs to assign a priority level; and (c) using ACTS to create an incident record with start and end dates for all Federal 24-Hour Report assessments and to record priority assignments.
270248	No	$0	$0
6. We recommend that the Florida Agency for Health Care Administration, Division of Health Quality Assurance establish and implement written policies and procedures for managing incident report late filings and consider immediately initiating onsite surveys of nursing facilities that file Federal 24-Hour Reports late.
270249	No	$0	$0
7. We recommend that the Florida Agency for Health Care Administration, Division of Health Quality Assurance establish and implement written policies and procedures for managing APS complaint notifications and conducting assessments of APS complaints to identify and survey more facilities where resident harm may have been caused by nursing facility noncompliance.