Stiff fines rare in Ohio nursing homes' violations

The average fine paid by Ohio nursing homes over the past three years for accidental injuries, neglect and other deficiencies was $8,128, or about $2,000 below the national average, according figures from the U.S. Centers of Medicare and Medicaid Services (CMS) recently compiled by ProPublica.

On a state-by-state comparison, Ohio was the 20th most punitive state in the country based on the average fine per nursing home. Washington State led the nation with an average fine of just over $90,000 per nursing home, while neighboring Oregon recorded the lowest average fine of about $1,300 per home, based on calculations dividing the total number of nursing homes by the total amount of fines levied in each state.

Across the country, the top five nursing homes with the most fines over that the past three years were Unihealth Post-Acute Care in South Carolina ($737,000); Cobb Health Care Center in Georgia ($592,000); Princeton Health & Rehab Center Inc. in Kentucky ($560,00); Universal Health Care in North Carolina ($547,00); and Bristol Nursing Home in Tennessee ($525,000).

Such large fines are uncommon in Ohio, where the stiffest fine in the state over the past three years — about $250,000 — was levied against Liberty Nursing Center of Oxford. Liberty was followed by Elisabeth Sev Prentiss Center in Cleveland ($232,000); Mcv Health Care Facilities in Mason ($169,943); Fairview Skilled Nursing in Toledo ($122,000); and Brookview Healthcare Center in Defiance ($106,400).

No other nursing homes in the state paid fines totaling more than $100,000 over the past three years.

Maintaining regulatory control of Ohio’s 956 nursing homes, the third-highest number in the country behind only Texas and California, is a major challenge, said Beverley Laubert, Ohio’s long-term care ombudsman.

Fines are just part of a multi-pronged effort to improve the quality of care in Ohio’s nursing homes, she said.

“The intent is not to punish nursing homes. The intent is to get facilities to improve,” Laubert said. “The fines are just one piece of that.”

Sanctions against nursing homes can also include halting Medicaid payments for new admissions, otherwise known as payment suspensions, which at least one expert thinks should be used more often.

Ohio had 47 instances of nursing home Medicaid payment suspensions over the past three years.

“Most nursing homes get the majority of their revenues from Medicaid, so suspending payments is by far the best mechanism for improving care,” said John Bowblis, a health economist at Miami University. “It forces the nursing home to act faster in terms of remedying the issue…or they will have less of an ability to attract new residents and get revenue from them.

“If you’re just paying a fine, you don’t necessarily have to remedy the issue,” he said.

Tessie Pollock, a spokeswoman for the Ohio Department of Health, said fines can be imposed on one-time or per-day basis, accumulating until the deficiency is resolved.

But the state can only make recommendations to the CMS’ regional office, Pollock said. The Ohio Department of Health “does not have the authority to levy fines, and even though we can make recommendations to CMS, that agency is ultimately responsible for imposing the amount of fine they feel appropriate,” Pollock said.

CMS officials at the regional office for Ohio declined to comment for this story but acknowledged the government maintains flexibility in imposing fines because each situation is different in scope and severity.

In Ohio, serious deficiencies such as accidental deaths and sexual assaults by staff members warranted the stiffest fines, while fines for deficiencies that don’t jeopardize residents safety were much less.

But the government’s leeway in imposing fines has led to widespread inconsistencies across the country.

Nursing homes in Texas, for instance, had an average fine of $6,933 over the past three years, more than $1,000 lower than Ohio’s. But Texas had the eleventh-highest number of serious deficiencies reported to the CMS, while Ohio had the sixth lowest.

ProPublica is an independent nonprofit organization that specializes in investigative journalism. For a searchable database on nursing home fines, penalties and deficiencies, see ProPublica’s website at

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