Medicaid: Federal Look Behind Surveys Of Nursing Homes Upheld By Court
Legal Eagle Eye Newsletter for the Nursing Profession
June 1996
Federal authorities function administratively by monitoring the adequacy of state certification and inspection efforts. Federal authorities can also "look behind" state inspectors with on-site inspections of their own.
According to the court record, when Federal authorities from the regional office of the Health Care Financing Administration dropped in to inspect an intermediate care facility serving Medicaid beneficiaries, they found numerous violations.
The survey team found restraints left on residents without release for periods exceeding two hours, vest restraints applied improperly creating a risk of strangulation, frail residents being lifted and ambulated in a manner that posed a substantial threat of injury, failure by staff to observe hygiene practices creating a serious risk of infection, dirty and unlabeled personal items and equipment scattered throughout the facility, physical therapy being administered by an unqualified employee, inadequate physical therapy regimens, and discontinuation of physical therapy without a physician’s consultation.
Based on these violations, the facility’s Medicaid certificate was canceled. The matter went before an Administrative Law Judge, and then to the Federal courts, where the litigation has dragged on for nearly eight years.
Recently, the U.S. Eighth Circuit Court of Appeals attempted to clarify an important issue. Although state officials have the responsibility to promulgate state standards for Medicaid-eligible nursing facilities, and to enforce those standards through state certification and inspection, the Federal government still retains primary authority and responsibility to enforce Federal standards for patient care in Medicaid-eligible facilities. Federal authorities generally carry out their function administratively by monitoring the adequacy of state certification and inspection efforts. However, according to the court, Federal authorities can also "look behind" state inspectors with on-site inspections of their own. Nursing Facilities vs. Shalala, 78 F. 3d 403 (8th Cir., 1996).