When federal auditors reviewed Medicare claims that carried diagnosis codes for abuse or neglect, they found that most of the incidents in their sample happened in the patient’s own home. The HHS Office of Inspector General (HHS OIG) report also found that some of the potential abusers were health care workers, and that some incidents were never reported to law enforcement.
What the auditors reviewed
The audit, published in November 2023, looked at Medicare claims from 2019 and 2020. Auditors found 30,258 claims with diagnosis codes showing that a patient had been treated for abuse or neglect. They then took a random sample of 100 claims and reviewed the records behind them.
In 93 of the 100 sampled claims, the records showed potential abuse or neglect. Based on the sample, OIG estimated that about 27,500 of the claims involved potential abuse or neglect.
Where the incidents happened
The setting is what stands out. Of the 93 sampled incidents:
- 60 happened in the patient’s own home
- 17 happened in medical facilities, including 12 in nursing homes
- 13 happened in someone else’s home or a public place
- 3 happened in an unknown place
OIG also found that 14 of the 93 incidents involved a health care worker as the alleged perpetrator, and that 18 were not reported to law enforcement. The report does not break out how many involved sexual abuse, and it describes potential abuse, not proven crimes.
What OIG recommended and how CMS responded
OIG recommended that the Centers for Medicare & Medicaid Services (CMS) do more to use claims data to find incidents that go unreported. CMS agreed with all four recommendations. According to OIG, the recommendation on guidance to providers was implemented in October 2024, and the others remained open.
In its response, CMS said that more than 78 percent of the sampled incidents happened in a private home or public place, where it has limited oversight. It noted that providers who treat patients at home must follow their state’s mandatory reporting laws.
That answer points to a gap families should understand. CMS sets rules for Medicare-certified home health agencies, including a patient’s right to be free from sexual abuse and a duty for staff to report abuse right away. But much home care comes from state Medicaid programs, private agencies or caregivers hired directly, and each state sets its own reporting and licensing rules.
Why this matters for home care
The findings echo earlier OIG work. In a 2019 audit of skilled nursing facilities, OIG found that many incidents of potential abuse or neglect were not reported to state agencies as required. The 2023 audit suggests that reporting gaps can be even harder to close outside facilities.
A home can feel like the safest place to receive care. It can also be the most isolated. A caregiver may be alone with a person who cannot speak up, and there may be no one else to notice changes.
For a civil claim, questions often include how the caregiver was hired, whether required checks and supervisory visits happened, and whether earlier warning signs were reported. Our home health care sexual abuse page explains these questions in more detail.
What this means for survivors and families
If you notice unexplained injuries, fear of a certain caregiver or sudden changes in someone who gets care at home, you can report it to police or Adult Protective Services. You do not need proof first. 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.
