A federal law (OBRA) enacted in 1987 established a survey and inspection process for nursing homes which required the facilities to meet certain standards of care. The Center for Medicare and Medicaid Services (CMS) has responsibility for enforcing these standards but delegates the inspection and survey process to the various states. The problem: states are not doing a good job of conducting unannounced surveys and punishing those facilities which repeatedly provide substandard to care to its elderly residents.

Why do the states fail to police the nursing homes? Maybe it has something to do with money! Nursing home companies invest heavily in local and state politicians to ensure the failure to pass legislation unfavorable to the industry and to buy protection against fines and penalties levied by state officials, according to a September 2006 report by Consumer Reports. For example, the Virginia Health Care Association (an organization of nearly 300 licensed nursing and assisted living facilities) gave over $200,000 to state candidates in 2005 according to (a national nonpartisan, nonprofit organization). Moreover, Medical Facilities of America, Inc. and its affiliated companies and owners (the largest owner of nursing home beds in Virginia) contributed almost $60,000 to local politicians. The remainder of individuals/companies aligned with the nursing home industry contributed $46,000. That means over $300,000 in 2005 alone!

What do the nursing homes get in return for their cash contributions? According to Consumer Reports, the contributions “gives facilities the confidence to push back in so many ways, like appealing citations and sanctions because they know that state legislators tend to be very protective of homes in their districts,” says Iris Freeman, with Advocacy Strategy, a Minneapolis firm that works with community groups on behalf of the elderly and disabled. To verify these allegations one only need to look at a 2005 Report from the Office of Inspector General entitled: “Nursing Home Enforcement: The Use of Civil Money Penalties.” The report analyzed all cases in 2000 and 2001 in which a civil money penalty was imposed upon a nursing home for poor resident care. The findings: nursing homes paid only 42% of the penalty initially imposed due to reductions authorized by the states and delays in collecting payments. Many of the worst offenders never get fined to begin with. Consumer Reports concluded that, nationally, only 55% of the facilities that could have received a monetary penalty actually did.

As the saying goes, “Money Talks and B…S…Walks!

About the author

Dan Frith

Dan Frith has over 25 years of experience representing individuals and families in cases of medical malpractice throughout Virginia. He has been named "Best Medical Malpractice Attorney" by Roanoker Magazine and is a member of the Million Dollar Advocates Forum. To speak with Dan, contact him by email at

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