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Medicare Star Ratings Allow Nursing Homes to Game the System

Medicare’s hotel-style rating system for nursing homes is based on a “incomplete information that can seriously mislead consumers, investors and others about conditions at the homes,” according a New York Times investigation.

The government does not verify self-reported data that the reviews are based in large part on, according to the investigation. Staff ratings and quality statistics – which make up two thirds of the rating equation – are accepted without question after being reported by the nursing homes themselves.

The investigation led to Rep. Elijah Cummings (D-MD) calling for a governmental evaluation of the system, according to McKnights.com. Cummings asked to be briefed on the issue by the Centers for Medicare & Medicaid Services by today (Sept. 16).

Cummings also requested the CMS expand the system to support state-regulated enforcement of ratings as well as consumer complaints. He is just one of several legislators monitoring the issue, McKnights reported.

Forbes says the Medicare ratings are ranking the wrong things. Medicare’s ratings are based in safety, not quality, Howard Gleckman wrote on Forbes.com. “Safety is an element of quality but hardly the entire story,” Gleckman writes.

The New York Times reported that many facilities don’t live up to their score.

North American Health owns a chain of care facilities throughout Western states such as California that, for example, receive bonuses for maintaining their five-star rating. However, NAH residents are not immune to the consequences of neglect and mistreatment.

Rosewood Post-Acute Rehab, for example, in Sacremento, was fined by the State of California $100,000 for causing a woman’s death in 2006 by over-administering a powerful blood thinner, according to the New York Times. Rosewood was the subject of 102 official complaints from 2009 to 2013, however, kept its five-star rating, according to the New York Times. A advocacy group asserts that number is higher, at 164. The ratings do not factor in fines or consumer complaints with state agencies.

The Rosewood facility forces residents to live three-to-a-room and experiences shortages of everything from washcloths to quality staff, according to the New York Times. The facility has fielded “about a dozen lawsuits in recent years from patients and their families claiming substandard care,” according to the New York Times.

One woman who is suing the facility for failing to treat her mother, who died while living there, said she was fooled by the facility’s posh exterior.

The Times report said many nursing homes have “learned how to game the rating system,” and that the nearly half of the country’s nursing homes earned four- or five-star ratings in 2013. When the system began, in 2009, only 37 percent of nursing homes received such high ratings, according to the report.

Click here to read the entire New York Times report.

The Kosieradzki • Smith Law Firm represents clients in cases involving catastrophic injury caused by nursing homes and other care facilities that fail to provide proper care. If you believe your loved one has been harmed due neglect or abuse in a nursing home, take action and contact the Kosieradzki • Smith Law Firm online or call us toll-free at (877) 552-2873 to set up a no-cost, no-obligation consultation.