OIG to Study Fall Reporting

The Office of Inspector General has concerns about nursing homes reporting falls and other traumatic events. If a nursing home accepts Medicare or Medicaid (which the vast majority do), the operator is required to report resident falls in patient assessments. However, often this does not happen because preventable falls affects the Star rating for the nursing home.

CMS uses the self-reported information to determine the percentage of residents experiencing falls resulting in major injury for each certified nursing home. These percentages are posted on CMS’s Care Compare website to give consumers information about the relative performance of each nursing home.

OIG will study and assess the accuracy of the patient assessment data used to calculate nursing home fall rates. Specifically, claims data should identify hospitalizations due to falls with major injury among nursing home residents that are Medicare enrollees, including people who are dually enrolled in Medicaid. The number will not count falls where no hospitalization occurred or where the Facility covers up the fall.

The accuracy of self-reported data is no longer guaranteed.