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Medicare Ratings of Nursing Homes Found to Be Misleading and Lacking Regulation

For the past five years, Medicare has assigned ratings to nursing homes that reflect hotel style ratings. The star-based rating gives only one-fifth of the nation’s 15,000 nursing homes five stars. A recent examination by The New York Times revealed that in many cases these ratings are based on incomplete information and may be misleading or simply false.

The Medicare ratings are heavily relied upon by the public but were found to be largely based on self-reported data provided by the nursing homes themselves. Two of the three criteria used in ratings are self-reported, and data provided by the nursing homes is generally just accepted at face value to be accurate. The self-reported data includes staff levels and statistics on quality of care. Only information about annual health inspections is provided by an independent analyst.

It seems clear that there is a significant discrepancy between the self-reported data and reality. In the federal watch list for quality, nearly two-thirds of the 50 homes received four or five star ratings. Yet the nation’s very worst facilities are still able to receive very high ratings on the Medicare star ratings mainly as a function of the self-reported data. Even more concerning, the ratings seem to have become more lenient since their adoption in 2009. The percentage of four or five star rated homes has increased from 39 percent to 52 percent in 2013.

Many incidents are also not factored into the rating. For example fines, state enforcement actions, and consumer complaints are not accounted for. In one example, a California nursing home boasted a five star rating while receiving twice as many complaints as the state average. The study found that many consumers placed their loved ones in the home based on these ratings. Hospitals and doctors also rely on the rating system to determine the best placements for patients.

Federal officials claim that the rating system provides the nursing homes with incentives to improve quality of care. However, many argue that instead of actually improving care, the homes are only playing the system by attempting to raise their ratings without addressing many serious issues.

If your loved one has been harmed by nursing home negligence or nursing home abuse, contact a nursing home lawyer at Lopez McHugh to discuss the available legal options. Contact us today at (877) 703-7070 for a free initial case evaluation.