CMS: We don’t disclose nursing home fines when the owners refuse to pay

The federal agency that oversees nursing homes in the United States says it doesn't inform the public when homes are fined for poor quality care and instead discloses the penalties only if, and when, the fines are paid. (Photo by Bermix Studio via Unsplash)

The federal agency overseeing nursing homes says it only informs the public of fines against those facilities if, and when, the owners choose to pay the fines.

For most of the past year, the Centers for Medicare and Medicaid Services’ Care Compare website has falsely reported that the Dubuque Specialty Care nursing home in eastern Iowa had a perfect, deficiency-free inspection in June 2020. In fact, state inspectors found numerous, serious violations, and CMS imposed a fine of $84,825, which was immediately reduced to $55,136 once the home agreed to forego an appeal.

The Iowa Capital Dispatch asked CMS about the discrepancy in April. This week, an agency spokesman in CMS’ Office of Communications said “human error” had caused the agency to post a false deficiency-free inspection report for the Dubuque home on its website, though he was unable to say how or why such a report was created.

As for the website’s separate claim that the Dubuque home was never fined as a result of the June 2020 inspection, the spokesman attributed that assertion to the fact that “the facility has not yet begun to submit payments” toward the fine. He said CMS’ “normal process” in cases of unpaid fines is to refer the matter to an administrative contractor who will initiate collection by offsetting Medicare payments owed to the home. “Once this begins, the fine will be reflected on the Care Compare website,” the spokesman said.

Toby Edelman, senior policy attorney for the nonprofit Center for Medicare Advocacy and a nationally recognized expert in nursing home oversight, said she’s surprised by CMS’ stance as it appears to contradict the agency’s past position of reporting fines once they were finalized and imposed.

“So much of the information they report on their Care Compare website is inaccurate,” she said. “It’s just ridiculous.”

The June 10, 2020, inspection report for the Dubuque home that’s published on the CMS website is a single-page document stating, “No health deficiencies found.” The actual inspection report, written by the state officials who conducted the on-site visit 12 months ago, is 10 pages long and lists a litany of serious regulatory violations related to infection control. It alleges a nurse aide with a cough was allowed to work in the facility on three separate occasions last April before testing positive for COVID-19. The worker who handled the employee screening felt the aide shouldn’t be working but was overruled by management, according to inspectors.

Also, the aide who was sick reportedly told inspectors she did not have a face shield to wear during the last four night shifts she worked while feeling ill. In addition, the home’s administrator was also allowed to work in the building, despite shortness of breath. She tested positive for the virus five days later, the state report says.

In all, at least 43 residents of Dubuque Specialty Care had contracted COVID-19, and 11 of them died. But the Care Compare site suggests no violations were found during the June 10 inspection and no fines were ever imposed.

Given the CMS policy of not disclosing unpaid fines, it’s not clear what action, if any, CMS has taken against other Iowa care facilities cited for major violations.

For example, last June at Oskaloosa’s Crystal Heights Care Center, state inspectors cited the home for the “rampant” spread of COVID-19 that resulted in nine deaths and 54 of the 74 residents being infected. An $8,750 fine was proposed by the state, and then held in suspension to allow CMS to act. But according to the CMS website, no federal fines have been imposed against Crystal Heights during the past three years.

Another Iowa nursing home, the Cedar Falls Health Care Center, was cited last October for placing residents in immediate jeopardy. An inspector found a resident in a soiled bed, with labored breathing, open sores and blisters on her backside, dried vomit in her hair and a dislocated shoulder the staff knew nothing about. The resident was taken to a local hospital for emergency treatment and died three hours later in the emergency room. A $10,000 fine was proposed by the state, then held in suspension to let federal officials act. But according to CMS’ Care Compare site, the last time the Cedar Falls facility was subjected to a federal fine was in 2019.

At the Montrose Health Center last November, the home was cited for placing residents in immediate jeopardy by allowing COVID-positive workers to care for uninfected residents and for having COVID-positive and COVID-negative residents share the same room. The state proposed a fine of $7,250 and then held that fine in suspension to let federal regulators act. But according to CMS’ Care Compare website, no federal penalties have been imposed against Montrose Health Center during the past three years.

CMS’ Care Compare site is promoted as a tool to provide the general public with accessible information on quality-of-care issues in nursing homes. But CMS has long been accused of disseminating misleading or incomplete information via that site and its earlier incarnation, Nursing Home Compare.

Edelman noted that the CMS site only reports fines imposed as the result of inspections that took place within the previous three years, and because many of the biggest fines are appealed as part of a process that can take three years or more to complete, some of those fines remain forever unreported to the public, she said.

“So a lot of the the most serious penalties are never publicly reported,” she said. “There is so much inaccurate information that’s being put out through that website.”

In 2015, the Government Accountability Office began a review of the site in the wake of a New York Times report questioning the site’s accuracy. A year later, the GAO issued a report recommending improvements to the site and warning that CMS officials had “described a fragmented approach to reviewing and implementing recommended website changes.”

In 2019, the Center for Medicare Advocacy analyzed the civil money penalties CMS was reporting that it imposed against nursing facilities. In two-thirds of the cases that were reviewed, the site did not fully and accurately report the violations cited by CMS and the penalties imposed, the center found.

Clark Kauffman
Deputy Editor Clark Kauffman has worked during the past 30 years as both an investigative reporter and editorial writer at two of Iowa’s largest newspapers, the Des Moines Register and the Quad-City Times. He has won numerous state and national awards for reporting and editorial writing. His 2004 series on prosecutorial misconduct in Iowa was named a finalist for the Pulitzer Prize for Investigative Reporting. From October 2018 through November 2019, Kauffman was an assistant ombudsman for the Iowa Office of Ombudsman, an agency that investigates citizens’ complaints of wrongdoing within state and local government agencies.