Nursing Home Oversight:

Industry Examples Do Not Demonstrate That Regulatory Actions Were Unreasonable

HEHS-99-154R: Published: Aug 13, 1999. Publicly Released: Sep 13, 1999.

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Pursuant to a congressional request, GAO analyzed materials from the American Health Care Association (AHCA) to determine whether any cases reflected the actions of an overly aggressive regulatory process.

GAO noted that: (1) in each of the eight cases for which there was sufficient information for an objective assessment, GAO believes appropriate regulatory action was taken; (2) in these cases, either the surveyor's actions were justified or the Health Care Financing Administration (HCFA) or the state withdrew the initial actions after the nursing homes presented additional information; (3) in the remaining two cases, GAO was unable to obtain sufficient information to make a determination; (4) specifically, of the seven cases AHCA believes represent inappropriate citations, GAO found that in three of these cases a citation was justified; (5) in another two cases, the states withdrew the citations when the nursing homes supplied additional information not available to the surveyors, and for the final two, GAO was unable to obtain enough information to make a judgment; (6) in all three cases in which the homes were recommended for termination by a state agency, GAO believes the states and HFCA ultimately acted correctly in accordance with regulatory requirements; (7) furthermore, in only one of these cases did HFCA actually terminate the home from Medicare and Medicaid; (8) in the remaining two, HCFA rescinded the termination actions: in one case because deficiencies were corrected and in the other because of procedural errors by the state; (9) in GAO's analysis of the cases that AHCA selected as "symptomatic of a regulatory system run amok," GAO did not find evidence of inappropriate regulatory actions; (10) furthermore, in a recently released report in which GAO examined a random sample of 107 nursing home surveys containing 201 actual harm citations affecting one or a few residents, GAO found that 98 percent of the surveys documented that one or more residents had experienced actual harm; (11) moreover, two-thirds of these 107 nursing homes also were cited for actual harm or higher-level deficiencies in a prior or subsequent survey; (12) most of these repeat violators were cited for the same deficiency, and an additional 34 percent were cited for closely related deficiencies; and (13) GAO also found that most of the examples AHCA provided had deficiencies, in addition to those cited by AHCA, that caused harm to residents.

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