Nursing Home RUG

Make no mistake, the provision of healthcare services is a business. Unfortunately, our most vulnerable citizens suffer due to corporate attempts to increase their “bottom line.” Nursing homes are regulated by the government. They must provide reports, called MDS reports, to the Centers for Medicare and Medicaid Services detailing the level of care provided to their residents. The information is in turn translated into payment codes (RUG codes). All too often, the level of care is inflated on the MDS report in an effort to increase the daily payment provided to the nursing home. Unfortunately, what is on the MDS report does not reflect the actual care provided or the staffing advertised and reported. In an effort to save money, the nursing homes will often provide minimal staffing even when their reported MDS data indicates a higher staffing level is required. These low staffing levels lead to a deprivation of services, which if severe enough, can constitute patient abuse. Low staffing levels deprive dependent residents of essential services such as turning and repositioning, assistance with food and water, basic hygiene, and fall prevention.

Nursing homes have also tampered with medical records and actually created records after a law suit was filed. Often staff members simply “check the box” during their documentation without verifying if the entries are true and accurate. Care has been documented as provided but not actually done. I personally have reviewed dozens of cases where care was even documented as provided after the patient had been sent to the hospital or even died. Clinical Forensic Documentation Analyses of nursing home records have shown all wound care records stating that severe pressure ulcers were present on admission were created after the resident was sent to the hospital with sepsis from multiple stage 4 pressure ulcers. The pressure ulcers were NOT present on admission; and in the deposition, the wound nurse admitted to entering the false data.

Not all nursing homes are understaffed or file falsified reports to the government. However, those that increase their profits while saving money by depriving residents of basic human services need to be held accountable. Please click on the following link to see how Pennsylvania Attorney General, Bruce Beemer is taking action. [Note – this article is no longer available.]


Gonsman Group is a full-service legal nurse consulting group. We provide a wide array of services for any case where a medical record and healthcare are involved. In addition to the variety of legal nursing services, Michele Gonsman provides Clinical Forensic Documentation Analysis. Michele had spoken across the country regarding the electronic medical record and audit trails.



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