CMS Did Not Accurately Report on Care Compare One or More Deficiencies Related to Health, Fire Safety, and Emergency Preparedness for an Estimated Two-Thirds of Nursing Homes

Why OIG Did This Audit

On behalf of the Centers for Medicare & Medicaid Services (CMS), State survey agencies perform inspections of Medicare- and Medicaid-certified nursing homes to determine whether they are in compliance with Federal health, fire safety, and emergency preparedness requirements. State survey agency surveyors cite instances of noncompliance as deficiencies and report inspection results to CMS. CMS makes the inspection results available on Care Compare, a CMS website that provides information on health care providers that consumers can use to make informed decisions about health care.

Our objective was to determine whether CMS accurately reported on Care Compare the deficiencies related to health, fire safety, and emergency preparedness that were identified during inspections of nursing homes.

How OIG Did This Audit

We selected a random sample of 100 nursing homes from among 15,377 nursing homes nationwide. For each sampled nursing home, we compared the deficiencies that had been reported on Care Compare as of December 10, 2020, with the deficiencies that State survey agency surveyors had documented in inspection reports from the three most recent yearly health, fire safety, and emergency preparedness inspections and the results of the most recent 3 years of complaint inspections.

What OIG Found

For 67 of the 100 sampled nursing homes, CMS did not accurately report on Care Compare 1 or more deficiencies that surveyors identified during yearly and complaint inspections. The deficiencies consisted of health deficiencies for 34 nursing homes, fire safety deficiencies for 52 nursing homes, and emergency preparedness deficiencies for 2 nursing homes. In addition, for 42 of the 100 sampled nursing homes, CMS did not report on Care Compare the results of all yearly fire safety and emergency preparedness inspections.

On the basis of our sample results, we estimated that 10,303 nursing homes had 1 or more deficiencies identified during inspections that were not accurately reported on Care Compare. Specifically, we estimated that 5,228 nursing homes had health deficiencies, 7,996 nursing homes had fire safety deficiencies, and 308 nursing homes had emergency preparedness deficiencies that were not accurately reported on Care Compare. In addition, we estimated that for 6,458 nursing homes CMS did not report on Care Compare the results of all yearly fire safety and emergency preparedness inspections.

What OIG Recommends and CMS's Comments

We recommend that CMS: (1) correct the inaccurately reported deficiencies that we identified for the sampled nursing homes; and (2) strengthen its processes for reviewing inspection results reported on Care Compare by requiring State survey agencies to verify the deficiencies reported, providing technical assistance and additional training to State survey agencies, and verifying that nursing home inspection results are accurately reported. The report has three other procedural recommendations.

CMS concurred with the second part of our last recommendation-that it provide technical assistance and additional training to survey agencies-but it did not state whether it concurred with our remaining recommendations. CMS provided information on actions that it had taken or planned to take to address some of those recommendations. After reviewing CMS's comments, we revised our first recommendation to clarify that CMS should correct the inaccurately reported deficiencies we identified for the sampled nursing homes. We also revised the first part of our last recommendation to clarify that the verification should be performed when a State survey agency is preparing to conduct an inspection. We maintain that our recommendations, as revised, are valid.