“Documentation Errors”

CMS’s new audit findings confirm what families and plaintiff attorneys have been saying for decades: these aren’t harmless “documentation errors.” They are the natural result of a corporate nursing home model built on profit extraction, understaffing, and cutting corners. Nursing homes now lead the nation in improper payments — because the paperwork is being manipulated to justify billing for care that too often never happened.

Most large operators don’t treat their facilities as places of care. They treat them as financial assets. Money flows upward through related-party management companies, inflated rent, and consulting fees paid to businesses the owners also control. Meanwhile, the actual facility — the place where residents live — is left with too few staff, too little training, and no capacity to meet even the most basic documentation standards.

That’s why CMS is tightening audits. When staff are overwhelmed and turnover is constant, the expectation becomes “chart it anyway,” even if the care wasn’t provided. MDS assessments get inflated, minutes get exaggerated, and cut-and-paste care plans mask real declines in residents’ health. And sloppy documentation almost always reflects sloppy care: skipped medications, ignored wounds, missed infections, and emergencies no one noticed until it was too late.

The industry counts on the fact that families never see the financial shell games behind the scenes — the self-dealing, the siphoned money, the deliberate starvation of frontline staffing budgets. CMS is finally seeing it in the numbers: when corporate owners build a system around maximizing revenue and minimizing payroll, fraudulent documentation isn’t an accident. It’s an inevitability.

Stricter audits are a start, but they won’t fix the deeper problem. Until ownership structures and related-party transactions are forced into the light, residents will keep paying the price — in preventable injuries, missed care, and lives cut short by a system designed to enrich everyone except the people living in these homes.