Nursing home operators lose 93% of appeals: report

The federal government won 66 of 71 appeals cases brought by nursing home providers last year according to a recent report from the Center for Medicare Advocacy. The Centers for Medicare & Medicaid Services won all 18 cases decided on the merits at the Appellate Division; it won 48 of 53 cases at the Civil Remedies Division.

The report author used the findings to call for stricter regulatory oversight of facilities. It is believed to be the first such examination of nursing home appeals findings in citations of poor care, she said.

"The study shows not only that problems in care are serious and that penalties are modest, but also that facilities choose to appeal these enforcement actions throughout he administrative appeals process. Almost always the facilities lose their cases," said report author Toby S. Edelman, a senior policy attorney for the Center for Medicare Advocacy.

She called for an upgrade of the regulatory system, including higher fines for deficiencies. Her analysis, "Nursing Home Decisions of the Department of Health and Human Services' Departmental Appeals Board, 2007," can be found at http://www.medicareadvocacy.org.

Norman DeLisle, MDRC
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