The North Carolina Department of Health and Human Services, including the Division of Health Services regulation that monitors adult care homes, is housed on the campus of the former Dorthea Dix state mental hospital in Raleigh. Frank Taylor / Carolina Public Press

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State health officials have been failing to follow-up sufficiently on about one in every 20 cases in which they find a nursing home has deficiencies, according to a federal audit report released last month.

Whether that is good or bad news, and whether it’s even accurate, depends on whom you ask.

Titled “North Carolina Did Not Always Verify Correction of Deficiencies Identified During Surveys of Nursing Homes Participating in Medicare and Medicaid,” the report appears negative on the surface. But this level of alleged failures is well below those that the U.S. Department of Health and Human Services Office of Inspector General has identified when conducting similar audits in some other states.

North Carolina officials have balked at the findings and issued a rebuttal that is included in the final report.

In conducting its audit last year, the federal agency looked back at records of some 3,850 nursing home deficiencies that required corrective action in 2015, ultimately selecting a random sampling of 100 deficiencies to analyze, Kelly Haight, a state DHHS spokesperson, told Carolina Public Press. The state does not agree with the federal findings regarding some of those cases.

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“The OIG determined that North Carolina did not verify the correction of five deficiencies in the 100 sampled,” wrote Cindy Deporter, who works as the state survey director for North Carolina’s Nursing Home Licensure and Certification Section, in the state’s letter rebutting the federal findings. “North Carolina concurs with OIG’s determination on one of the five sampled deficiencies.  As to the remaining four sampled deficiencies … North Carolina does not concur with OIG’s determinations on these four.”

Even so, the state has accepted the federal guidance for corrective action.

“Nonetheless, … North Carolina concurs with the OIG’s recommendations,” Deporter’s letter continued.  “(The NC Division of Health Service Regulation within NC DHHS) appreciates the OIG’s review of its important work as the state survey agency, the professionalism of OIG’s auditors and the opportunity to take action to improve its survey process.”

Haight noted that despite the disagreements over the reports’ findings, this audit did find that North Carolina had done well in the vast majority of cases, which was not always the case in other states that have faced similar audits.

“They (federal auditors) did find that (the state Division of Health Service Regulation) verified corrective actions being taken in accordance with the federal requirements for 95 percent of the deficiencies identified during surveys in 2015,” Haight told CPP.

“This is an estimated five percent error rate. By comparison, the OIG found much higher error rates in audits of other states.”

The federal report also directly acknowledges this distinction. Other recent audits also found deficiencies without sufficient verified corrections at nursing homes in six states. It’s unclear how many states were surveyed without any such findings, because the reports only exist for those that were found to fall short of complete verification.

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Whereas the federal audit found about 5 percent of cases in which North Carolina could have done better, the federal audit for New York found 51 percent of cases in which that state did not verify corrections at nursing homes, with another 6 percent in which there was insufficient documentation of corrections. Kansas also had a 51 percent non-verification rate.

Although states employ different statutory categories for various types of long-term care facilities, the federal auditors identified “nursing homes” in each state base on the facilities that Medicaid and Medicare have listed as qualified nursing homes for compensation purposes, according to Don White, senior community relations special for the Office of Inspector General at US DHHS.

Because of this way of ensuring a consistent definition of “nursing home,” the records from different states should be roughly comparable.

Frank Taylor

Frank Taylor is the managing editor of Carolina Public Press. Contact him at ftaylor@carolinapublicpress.org.

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