GAO Reports To Senate On Pre-COVID-19 Infection Control Deficiencies In Nursing Homes

Written by: John E. Hall, Jr., Esq. and Drew Graham, Esq.

In spring 2020, Senator Ron Wyden (D-OR) asked the Government Accounting Office (“GAO”) to analyze the Centers for Medicare & Medicaid Services’ (“CMS”) oversight of infection control in nursing homes. On May 20, 2020, GAO issued the first of several responsive reports, focusing on issues arising before the COVID-19 pandemic.

Scope of Sen. Wyden’s Inquiry
Sen. Wyden asked GAO to examine three main matters:

      • CMS’s oversight of infection prevention and control protocols,
      • The adequacy of emergency preparedness standards for emerging infectious disease in nursing homes, and
      • CMS’s response to the pandemic.


GAO’s May 20 letter summarizes its audit, which was conducted from April 2020 to May 2020, evaluating data from 2013 – 2017. Future responses will address the other matters raised by Sen. Wyden.

GAO’s Findings
GAO began by noting that CMS monitors 15,500 nursing homes throughout the United States. CMS data show state surveyors reported numerous infection and prevention control deficiencies (the most common type of deficiency cited), specifically:

      • Over the span of all years, 2013 – 2017, deficiencies were noted at 82% of nursing homes (13,299 nursing homes.)
      • In each year, approximately 40% of all nursing homes had deficiencies.
      • Approximately 35% of all nursing homes had deficiencies noted in three or four consecutive years.
      • Approximately 6% of all nursing homes had deficiencies noted in all five years.


GAO highlighted that 99% of all deficiencies noted were classified as “not severe.” 67% of the “not severe” deficiencies did not result in any enforcement action. Another 31% had an enforcement imposed but not implemented (i.e., the deficiency was corrected before the enforcement could by implemented.)

GAO also analyzed specific characteristics of nursing homes including:

      • Type of ownership (for-profit, nonprofit, government-owned, or mixed ownership),
      • Location (urban, rural, or transitioning area),
      • Number of Medicare and Medicaid certified beds (less than 50, 50-99, 100-199, or 200 or more),
      • Special Focus Facility program membership, and
      • Average of Five-Star System overall quality ratings.


For-profit facilities, large facilities, special focus facilities, and facilities with rankings of 1, 2, or 3 stars all accounted for a larger-than expected number of deficiencies cited in multiple years. (For example, 67.9% of all nursing homes were for-profit, but those homes accounted for 72.3% of homes with cited deficiencies in multiple years.)

GAO’s letter is only the beginning of a governmental analysis of nursing homes’ responses to COVID-19. More analyses will follow in the coming months. We will continue to keep you informed during this volatile time.

Leave a comment