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Audit Finds the Department of Public Health Isn’t Collecting Fines Against Nursing Homes for Abuse and Neglect

On June 17, 2010, the California State Auditor released a report blasting the Department of Public Health (DPH) for its chronic failure to collect fines imposed on nursing homes and its mismanagement of the fines it has collected. The Joint Legislative Audit Committee approved the audit in February 2010.

The report is the latest sign that DPH is protecting nursing home operators instead of residents who have been subjected to abuse and neglect. The report is titled, "Department of Public Health: It Reported Inaccurate Financial Information and Can Likely Increase Revenues for the State and Federal Health Facilities Citation Penalty Accounts."

California law authorizes DPH to issue fines against nursing homes for abuse and neglect of residents and requires it to use the money collected for the benefit of residents.

Here are some key findings:

  • During the seven-year period reviewed by the audit, DPH reduced fines for appealed citations by an average of 59 percent, which amounted to more than $2.7 million.
  • Of the more than 1,400 citations that facilities have appealed since fiscal year 2003-04, about 1,000, or 69 percent, were still pending. As a result, nearly $9 million in outstanding fines have not been collected.
  • DPH could have collected nearly $3.3 million more if the fines had been adjusted to reflect the rate of inflation.
  • DPH inappropriately granted a monetary reduction of 35 percent for 135 citations.
  • It may not be identifying violations that would trigger citations because it is not conducting state inspections on a timely basis.
  • Due to poor internal controls, DPH overstated the fund balance in the federal citation penalty account. DPH overstated the amount in the account by $9.9 million in fiscal year 2008-09. The federal account is nearly insolvent.

The report explains that nursing home operators routinely file appeals rather than pay the fines because they know DPH is very likely to dramatically reduce the fine during the appeal process. It cites an example where the fine was reduced by 99 percent –from $100,000 to just $1,000 – in a case where DPH determined that a resident’s death was caused by the nursing home’s neglect.

Although not mentioned in the report, Medi-Cal pays nursing home legal fees when they appeal fines issued by the State. The State and taxpayers are subsidizing nursing home operators to defend abuse and neglect. Victims of abuse get no help from the State.

DPH’s failure to collect the fines is also jeopardizing the ability to use the citation accounts to help fund the long term care ombudsman program.

The reports contains several good recommendations, such as collecting the fines when they are imposed and increasing the fines to reflect the rate of inflation.

Read the report (

Read California Watch’s article on the audit findings

Read the Sacramento Bee’s article on the audit

Read the AP/San Jose Mercury News 6/17/10 article