A federal audit of more than 4,000 New Jersey nursing home residents who were sent to hospitals in 2016 found that long-term care facilities were likely missing red-flags suggesting patient abuse.

Inspectors said that the lack of documentation for conditions like bed sores, sepsis, or head injuries raised concern that cases of abuse or neglect were not being properly reported.

In a report issued Wednesday through the U.S. Department of Health and Human Services Office, auditors estimated that out of 4,402 hospital claims involving Medicaid recipients, 311 were a result of potential abuse or neglect at a nursing facility in New Jersey.

The auditors estimated that of those, 220 claims were potential abuse or neglect that nursing facilities did not investigate and report to the state.

The audit also estimated that 616 claims did not have enough documentation on circumstances of the patient’s injuries or condition in order to determine whether it was a result of potential abuse or neglect.

The report is a snapshot of conditions long before the coronavirus pandemic that erupted in March this year. The facilities and state officials have been under fire as the COVID-19 death toll among nursing home residents and staff has topped 7,000, nearly half of all deaths in the state.

The findings were based on a review of 103 sample cases from among the claims, involving roughly 30 cases of pressure ulcers or bed sores, 11 unspecified head injuries and eight cases of severe sepsis with septic shock, among other conditions.

Cuts, bumps, bruises, broken bones and other unspecified cases of nursing home patients who fell were among the cases in the audit.

Out of the 103 sample claims, 10 claims were cases of potential abuse or neglect that should have been reported to the state but only five were.

For another 14 claims in the sample, nursing facilities did not provide enough documentation for state officials to determine whether an incident should have been investigated.

Of the sample cases, three were classified as “significant at-risk,” involving an accusation of adult sexual or physical abuse. All three of those cases were reported and documented as required, the audit said.

The draft of the report was received by state officials in early summer.

In a June 24 letter included in final documents, state Health Commissioner Judith Persichilli confirmed receiving sample results from federal investigators and noted that since 2016, nursing homes now can electronically report potential cases of patient neglect or abuse, in addition to faxing or calling in such events.

Persichilli said state officials delivered in-person presentations between 2017 and 2019 on the updated method for reporting claims, but that due to the COVID-19 pandemic, planned presentations for 2020 have not yet happened.

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