Nursing homes underreporting Medicare patient falls by as much as 43%: HHS Inspector Gen.

Nursing homes in official resident assessments "failed to report" 43% of falls involving Medicare enrollees as required by law, according to a new U.S. Department of Health and Human Services Inspector General (IG) report.

The IG found in a report that falls that were not reported from July 2022 through June 2023 had involved "major injury and hospitalization."

According to the IG report, "for-profit and chain nursing homes as well as larger nursing homes failed to report falls most often" and the lack of fall reporting was worse in non-rural nursing homes.

"Nursing homes failed to report falls more often for younger residents, male residents, short-stay residents, and residents with only Medicare coverage," the IG stated.

The failed reporting of falls, the IG found, damaged the overall quality evaluation of services provided by Care Compare, a program under the wing of The Centers for Medicare & Medicaid Services (CMS). That program says it "provides a single user-friendly interface that patients and caregivers can use to make informed decisions about healthcare based on cost, quality of care, volume of services, and other data."

Low rates of reported patient falls may be due to underreporting

Based on the IG review, the nursing homes with "the lowest fall rates on Care Compare were the least likely to report the falls" that the IG had examined for its report. 

"This suggests that low fall rates for nursing homes on Care Compare are likely driven by nursing homes’ failure to report falls, rather than an actual low incidence of falls," the agency's watchdog said. 

"As a result, Care Compare does not provide the public with accurate information about how often nursing home residents fell," the IG added.

The watchdog made two recommendations for the CMS

"CMS should take steps to ensure the completeness and accuracy of the nursing home-reported MDS data used to calculate the quality measures for falls with major injury," the IG said.

The Inspector General's report also said that "CMS should explore whether approaches to improve the quality measures related to falls could similarly be used to improve the accuracy of other nursing home quality measures."