CMS Will Now Post All Civil Money Penalties Imposed Against Nursing Facilities

In response to questions from reporters, the Centers for Medicare & Medicaid Services (CMS) stated it will now publicly post all civil money penalties imposed against nursing facilities, whether or not the fines have been paid.  Until now, CMS apparently did not publicly disclose unpaid fines.  CMS’s former policy rewarded bad behavior by facilities – refusal to pay fines – by keeping the federal fines hidden from public disclosure.  The change in policy reflects both the importance of the media in identifying and exposing poor public policies and the responsiveness of the Biden Administration and its willingness to undo inappropriate policies of prior administrations.

In June 2021, the Iowa Capital Dispatch reported that an $84,825 fine imposed against Dubuque Specialty Care (and automatically reduced by 35% to $55,136 when the facility chose not to appeal) was not reported on the federal website Care Compare.  CMS told reporter Clark Kauffman that CMS posts fines only if and when facility owners pay the fines.[1]  Kauffman also reported in June that the federal website indicated that the Iowa nursing facility had no deficiencies, as of its June 10, 2020 inspection, although a survey report a year earlier actually cited a number of serious deficiencies related to infection control.

CMS told Kauffman in December 2021 that it is now publicly posting fines, whether or not the nursing facilities have paid them.[2]

A second reporter, Jocelyn Wiener of CalReports, reviewed federal fines exceeding $100,000 that were imposed against California nursing facilities since 2018, as reported on the federal website qcor.[3]  When she compared the qcor information with information reported on Care Compare, she found that only 14 of the 50 large fines were reported on the publicly-facing Care Compare website.  She found, for example, that the largest federal fine imposed against a California nursing facility – $912,404, imposed at Northpointe and reduced by 35% to $593,000 when the facility did not appeal – did not appear on Care Compare. 

CMS originally gave Wiener multiple reasons that the Northpointe fine could not be found – “representatives said that it must not have the data, the data should be findable in the archives (it wasn’t); it had been more than three years since the Northpointe fine.”  On December 7, CMS said it did not post unpaid fines.  As Wiener prepared to publish her findings, CMS changed its policy and notified her on that it would post all fines.[4] 

The New York Times reported on December 10, 2021 that “Much of the data that powers the [federal Care Compare rating] system is wrong and often makes nursing homes seem cleaner and safer than they are.”[5]  The New York Times attributed inadequacies in the Care Compare website to multiple factors: the “secretive appeal process” (both the informal dispute resolution process and the formal appeals process to Administrative Law Judges); the inappropriate classification of deficiencies as causing no harm to residents; surveyors’ expectations of challenges to their citing deficiencies; and survey agencies’ encouraging facilities to improve, rather than citing deficiencies and imposing penalties.

The Center for Medicare Advocacy has reported for a decade on the federal website’s failure to provide the public with accurate information about deficiencies, penalties, and star ratings.[6]

___________________

[1] Clark Kauffman, “CMS: We don’t disclose nursing home fines when the owners refuse to pay,” Iowa Capital Dispatch (Jun. 8, 2021), https://iowacapitaldispatch.com/2021/06/08/cms-we-dont-disclose-nursing-home-fines-when-the-owners-refuse-to-pay/ 
[2] Clark Kauffman, “Federal agency says it now discloses all nursing home fines,” Iowa Capital Dispatch (Dec. 13, 2021), https://iowacapitaldispatch.com/2021/12/13/federal-agency-says-it-now-discloses-all-nursing-home-fines/ 
[3] QCOR, Quality Certification & Oversight Reports, is at https://qcor.cms.gov/main.jsp 
[4] Jocelyn Wiener, “The case of the vanishing fine: How a massive nursing home penalty eluded consumer detection,” CalMatters (Dec. 15, 2021), https://calmatters.org/health/2021/12/rechnitz-nursing-home-fines/?utm_source=CalMatters+Newsletters&utm_campaign=fab7c297cf-WHATMATTERS&utm_medium=email&utm_term=0_faa7be558d-fab7c297cf-150217021&mc_cid=fab7c297cf&mc_eid=f773cc7d86 
[5] Robert Gebeloff, Katie Thomas, and Jessica Silver-Greenberg, “How Nursing Homes’ Worst Offenses Are Hidden from the Public,” The New York Times (Dec. 10, 2021), https://www.nytimes.com/2021/12/09/business/nursing-home-abuse-inspection.html?searchResultPosition=1 
[6] See CMA, “Special Focus Facility Study: Nursing Facilities’ Self-Regulation Cannot Replace Independent Surveys,” (CMA Alert, Dec. 22, 2011), https://medicareadvocacy.org/special-focus-facility-study-nursing-facilities-self-regulation-cannot-replace-independent-surveys/.  See full study, “Nursing Facilities’ Self-Regulation Cannot Replace Independent Surveys: A Study of Special Focus Facilities, Their Health Surveys, and Their Self-Reported Staffing and Quality Measures,” https://www.medicareadvocacy.org/wp-content/uploads/2011/12/SFFs-12.2011.pdf  
    CMA, “Don’t be Fooled by the Federal Nursing Home Five-Star Quality Rating System” (CMA Alert, Oct. 5, 2016), https://www.medicareadvocacy.org/dont-be-fooled-by-the-federal-nursing-home-five-star-quality-rating-system/         CMA, “Nursing Facility’s ‘Quality Measures’ Do Not Reflect Actual Quality of Care Provided to Residents” (CMA Alert, Aug. 9, 2018), https://www.medicareadvocacy.org/nursing-facilities-quality-measures-do-not-reflect-actual-quality-of-care-provided-to-residents/
     CMA, “Special Focus Nursing Facilities that ‘Have Not Improved:’ Poor Care for Residents, Overall Ratings Artificially Boosted by 5-Star Ratings in Self-Reported Quality Measures” (CMA Alert, Aug. 15, 2018), https://www.medicareadvocacy.org/special-focus-nursing-facilities-that-have-not-improved/
   CMA, “There’s Nothing Special About How CMS Treats Special Focus Nursing Facilities” (CMA Alert, Feb. 14, 2019), https://medicareadvocacy.org/theres-nothing-special-about-how-cms-treats-special-focus-nursing-facilities/.  See full Report, “There’s Nothing Special About How CMS Treats Special Focus Nursing Facilities,” at https://www.medicareadvocacy.org/report-theres-nothing-special-about-how-cms-treats-special-focus-nursing-facilities/
     CMA, “Nursing Home Compare Inaccurately Reports Civil Money Penalties Imposed Against Nursing Facilities” (CMA Alert, May 30, 2019), https://medicareadvocacy.org/nursing-home-compare-inaccurately-reports-civil-money-penalties-imposed-against-nursing-facilities/ 
    CMA, “‘Graduates’ from the Special Focus Facility Program Provided Poor Care” (CMA Alert, Jun. 20, 2019), https://www.medicareadvocacy.org/graduates-from-the-special-focus-facility-program-provided-poor-care/     
CMA, “Nursing Home ‘Quality Measures’ Do Not Reflect Quality of Nursing Home Care” (CMA Alert, Jul. 3, 2019), https://www.medicareadvocacy.org/nursing-home-quality-measures-do-not-reflect-quality-of-nursing-home-care/     
CMA, “Poorly Performing Skilled Nursing Facilities: What Happens to Them?” (CMA Alert, Nov. 7, 2019), https://medicareadvocacy.org/poorly-performing-skilled-nursing-facilities-what-happens-to-them/