A September 2026 audit by the HHS Office of Inspector General found that the Centers for Medicare & Medicaid Services (CMS) did not provide adequate oversight of how states use contract workers to inspect nursing homes. Those inspections, called surveys, are how complaints about abuse are checked and how problems end up in public records. CMS agreed with the report’s two recommendations.
What the audit found
CMS oversees about 15,000 nursing homes but relies on state survey agencies to inspect them. According to the audit, states have increasingly turned to contract surveyors because of staffing shortages and inspection backlogs made worse by the COVID-19 pandemic.
OIG reviewed 14 states and found that CMS did not provide adequate oversight of their use of contract surveyors. CMS had issued a memo with expectations for states, but OIG found it did not monitor whether states followed it. All 14 states could have improved their policies, the audit said.
OIG made two recommendations:
- Add information to CMS’s survey data system showing whether each surveyor is a state employee or a contractor
- Confirm that states have policies in place for using contract surveyors
According to the report page, CMS concurred with both. OIG lists March 1, 2027 as the expected date for updates on the recommendations.
Why inspections matter in abuse cases
Inspections are one of the main ways an outside agency looks at what happens inside a nursing home. When a family or staff member files a complaint about abuse, the state survey agency may investigate. If inspectors find that a facility broke federal rules, they cite a deficiency, and that finding becomes part of the public record.
Federal rules at 42 CFR 483.12 require nursing homes to protect residents from sexual abuse and to report abuse allegations to the administrator and state officials within 2 hours. The facility must investigate, protect residents during the investigation and report the results to the state within 5 working days. Inspectors check whether facilities followed those steps.
Earlier OIG work shows why this oversight matters. In a 2019 audit, OIG estimated that 1 in 5 high-risk emergency room claims for skilled nursing facility residents in 2016 were the result of potential abuse or neglect. It found that facilities did not report many of the sampled incidents to state agencies as required.
The new audit does not find that contract surveyors did poor work. Its finding is about oversight: whether CMS and states had the policies and data needed to make sure inspections are consistent, whoever does them.
How families can use inspection records
Medicare’s Care Compare website shows ratings and inspection results for nursing homes that take part in Medicare or Medicaid. Families can use it to see cited problems, including those tied to abuse or failure to report. State survey agencies may also post full inspection and complaint reports.
A clean inspection history does not mean abuse never happened. Many incidents are never reported, and inspections are snapshots in time. But when there are citations, they can help show what a facility knew and when. In a civil case, a lawyer may look at those records alongside medical charts, incident reports and staffing records. Our nursing home sexual abuse page explains which records may matter.
What this means for survivors and families
If you suspect abuse, you can file a complaint with your state survey agency, contact the long-term care ombudsman, report to Adult Protective Services, or call the police. Filing a complaint does not start a lawsuit. Deadlines for civil claims vary by state, and a lawyer can review the specifics. You can learn more in our sexual assault and abuse section.
This article is general information about how these cases work. It is not legal advice, it does not create an attorney-client relationship, and no two claims are alike. If something here sounds like your situation, the useful next step is a conversation about the facts.
