More than 25 percent of sexual and physical abuse allegations by seniors about their caregivers are apparently going unreported to police, according to a government audit, which accuses Medicare of failing to enforce a federal law that requires immediate notification of these crimes. The Health and Human Services inspector general’s (IG) office issued an “early alert” in August 2017 based on preliminary findings from case audits in 33 states. The results sufficiently alarmed investigators that they are pushing for immediate action. Using investigative data analysis, auditors from the IG’s office identified 134 cases, over a two-year period from 2015-2016, in which hospital emergency room records indicated possible sexual or physical abuse, or neglect, of nursing home residents. More than one quarter of these cases had not been reported to the police. “We hope that we can stop this from happening to anybody else,” says an audit manager with the IG’s office, the federal government’s investigative arm for fraud, waste and abuse in the health care system. The audit is part of a larger, continuing probe. Additional, more detailed findings may be expected. With a population of about 1.4 million people, U.S. nursing homes are concerned about quality of care. Nevertheless, in spite of such awareness, serious violations still occur. And of these unreported cases, almost 80 percent of them involved allegations of rape, sexual abuse or neglect of nursing home residents. Investigators used thoroughly audited computerized billing records to find these cases of possible abuse. Auditors identified 134 possible sexual or physical abuse offenses, and some investigators wonder if this might be only the tip of a larger “abuse” iceberg. The federal statute regarding abuse allegations in senior care facilities has been in force for more than five years, but investigators have learned that Medicare has not uniformly enforced the requirement to report incidents to police and other agencies. Penalties for not complying with these reporting regulations include fines of up to $300,000 per offense. They are clear in requiring nursing home personnel to immediately report incidents that involve a suspected crime no later than two hours after detection if the patient has suffered serious bodily injury from the abuse. If injuries are not observed, law enforcement authorities must be notified within 24 hours of detection of the event. Adding more challenges to the issue, the Trump administration plans to allow mandatory binding arbitration clauses to be a part of any admission contract for a long-term care facility that accepts federal money. This could hobble complaints that might involve allegations of abuse or neglect of residents. Consumer groups say mandatory arbitration clauses stack the deck against nursing home residents, preying on them during times of anxiety when they and their families struggle with a serious illness or try to find a long-term care solution. Under arbitration, complaints would be handled through negotiations with an arbitrator instead of in civil court before a judge or jury. Consumer groups have fought against these clauses for years. The number of nursing home residents is expected to grow as Baby Boomers live well into their 80s and 90s. Medicaid is the main payer for long-term care, and Medicare covers doctors’ services and hospital care for the elderly disabled. If your loved one has suffered nursing home abuse in Kentucky and you want to explore your legal options, call Billy Johnson. Contact us today at 606-437-4488, or fill out this online form to learn how we can help you. Your consultation is free, and we earn no fee unless we win your case.