OIG inspectors review payroll records for skilled care nursing facility

OIG recently inspected payroll records from a skilled nursing facility in the greater Houston area to determine if the hours of direct care provided by licensed nursing staff were accurately reported.  

During the inspection, it was determined that the facility had accurately reported hours worked on 88 percent of the 514 records under review. However, there was a concern that the facility did not have documented processes for reporting complete and accurate direct care licensed nursing hours to the U.S. Centers for Medicare and Medicaid (CMS) through the Payroll-Based Journal reporting system. As a result, they:  

  • Overreported and underreported some direct care licensed nursing hours worked.
  • Inconsistently accounted for required meal break deductions.

Additionally, they did not consistently maintain complete payroll records to document all direct care licensed nursing hours worked or the number of direct care hours worked by administrative staff.

Nursing facilities must electronically submit payroll data to (CMS) through a web-based platform that documents payroll data. This submission includes each direct care staff member's category of work, hours of care provided by each category of staff, full resident census data and staff turnover and tenure information, including hours worked and length of employment. 

To assist with their reporting requirements, the facility utilizes an electronic timekeeping system that uses fingerprint scans to account for patient hours. By default, this program utilizes a time rounding guideline known as the seven-minute rule, which rounds staff time to 15-minute increments. For example, if a staff member clocks in at 7:07 a.m., the program rounds the time down to 7:00 a.m., and if a staff member clocks out at 4:55 p.m., the time is rounded up to 5:00 p.m. 

Due to an inconsistent application of the seven-minute rule, OIG inspectors could not definitively quantify the number of direct care hours overreported and underreported within the provided documents. Facility management provided multiple methodologies for how the seven-minute rule is applied, ultimately all methods resulted in errors.  

Additionally, they provided a small number of payroll records that had missing staff time entries or did not identify the direct care hours provided by licensed staff whose primary current role at the facility is administrative. As a result, OIG Inspections could not verify the accuracy of 20 out of 512 submitted payroll records or compare them to payroll records submitted to CMS.  

OIG inspectors provided recommendations to assist the facility in addressing these areas of concern, which facility management indicate have already been implemented.