Under-Reported Falls at Nursing Homes Raise Concerns  

The Office of Inspector General (OIG) recently released a review highlighting significant gaps in how nursing homes report resident falls with major injury. The findings raise questions about the reliability of fall-related quality measures posted on CMS’s Care Compare website—data that families and referral sources rely on when evaluating nursing home care. 

Key Findings 

• 43% of major-injury falls went unreported. Nursing homes failed to document nearly half of falls that resulted in hospitalization on the federally required Minimum Data Set (MDS) assessments. 

• Certain providers underreported more often. For-profit, chain, and larger facilities, as well as nonrural facilities, showed the highest rates of missing reports. 

• Resident characteristics mattered. Falls were less likely to be reported for younger residents, men, short-stay residents, and those with only Medicare coverage. 

• Lowest “fall rates” may be misleading. Facilities showing the lowest fall rates on Care Compare were the least likely to report falls—suggesting their numbers reflect incomplete reporting rather than safer care. 

Because the MDS feeds directly into Care Compare’s publicly reported quality measures, inaccurate reporting means consumers, hospitals, and payers may be making decisions based on faulty information. 

OIG Recommendations 

The OIG urged CMS to: 

1. Strengthen oversight to ensure nursing homes submit complete and accurate MDS data for falls with major injury. 

2. Explore similar improvements across other nursing home quality measures. 

CMS agreed with these recommendations. 

What This Means for Providers 

Accurate, timely MDS reporting isn’t just a compliance requirement—it protects the integrity of publicly reported data and supports informed consumer choice. Facilities should review their internal fall documentation and reporting workflows to ensure every qualifying incident is captured. 

For post-acute and long-term care organizations, this is another reminder that data quality directly impacts both regulatory standing and public reputation. Hansen Hunter can help evaluate your reporting processes and prepare you for heightened CMS scrutiny.