Federal agency says it now discloses all nursing home fines

The federal agency that oversees nursing homes in the United States says it is changing policy and is now publicly posting all care facility fines regardless of whether they’ve been paid.

The change comes amid mounting criticism over the Centers for Medicare and Medicaid Services’ Care Compare website, which the agency promotes as a tool to provide the general public with information on quality-of-care issues in nursing homes.

In June, the Iowa Capital Dispatch reported that CMS was only informing the public of fines that it had imposed against care facilities if, and when, the owners paid those fines.

The agency acknowledged the practice after the Capital Dispatch asked why Care Compare had posted to its website a deficiency-free inspection report for the Dubuque Specialty Care nursing home dated June 2020. State records showed inspectors had found numerous, serious violations during their visit that month, and that CMS had imposed a fine of $84,825 against the facility.

A CMS spokesman attributed the false inspection report to human error. As for the 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 had not yet paid its fine. He said the agency’s “normal process” was to publicly report only those nursing homes fines that had been paid.

The Capital Dispatch asked CMS last week about unpaid fines levied against Iowa care facilities and the collection efforts undertaken to secure payment of the fines that were considered past due.

Agency spokesperson Julie Brookhart declined to answer the question, saying, “This information is not generally publicly available.” She suggested the Capital Dispatch file a formal Freedom of Information Act request for unspecified documents pertaining to every care facility that’s of interest to the Capital Dispatch.

The Capital Dispatch then asked Brookhart whether CMS was still publicly reporting only the fines that care facilities have paid.

A CMS spokesperson who declined to be identified by name responded by saying Care Compare now shows “all imposed fines,” although, the person added, there is a 90-day lag in reporting to account for the 35% fine reduction that CMS allows for facilities that waive their right to appeal.

The New York Times reported last week that the Care Compare site conceals from the public major quality-of-care issues at nursing homes due to a lengthy appeal process. The result, the Times reported, is a website that “makes nursing homes seem cleaner and safer than they really are.”

Toby Edelman, senior policy attorney for the nonprofit Center for Medicare Advocacy and a nationally recognized expert in nursing home oversight, complained to CMS recently about the fact that when nursing homes appeal a fine, even if that fine is upheld, public disclosure can still be delayed by two years or more. And if an appeal takes three years or more to resolve, that can result in the fine never being disclosed since Care Compare doesn’t report fines that are more than three years old.

“So much of the information they report on their Care Compare website is inaccurate,” Edelman told the Capital Dispatch earlier this year. “It’s just ridiculous.”

A spot-check of Care Compare indicates that at least some of the previously unreported fines levied against Iowa care facilities are now disclosed on the site.

For example, in June 2020, state inspectors visited Oskaloosa’s Crystal Heights Care Center and cited the home for the “rampant” spread of COVID-19 that resulted in nine deaths and 54 of the 74 residents being infected. Twelve months later, Care Compare site was reporting no federal fines had been imposed against the home during the past three years. Now, however, the site reports a fine of $57,120.

Another Iowa nursing home, the Cedar Falls Health Care Center, was cited in October 2020 for placing residents in immediate jeopardy. In June of this year, the Care Compare site made no mention of any federal fines. Now, however, the site shows a fine of $75,169.

In November 2020, the Montrose Health Center 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. In June of this year, Care Compare made no mention of a federal fine, but the site now reports a fine of $70,385.

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.