The New York Times has examined the rating system of nursing homes and found that most top-ranked nursing homes have been given the seal of approval based on incomplete and self-reported data.
The Medicare ratings are based in large part on self-reported data that the government does not verify. Only one of the three criteria used to determine star ratings, health inspections, relies on assessments from outside reviewers. The other measures, staff levels and quality statisitics, do not.
The ratings also do not factor in fines and other enforcement actions by state authorities, or complaints filed by consumers with state agencies.
Rosewood, a five-star nursing home in California, was fined $100,000 for causing the death of a woman who was given an overdose of a blood thinner. Rosewood has also been the subject of about a dozen lawsuits in recent years from patients and their families.
Due to the lack of oversight in the rating system, nursing homes have learned how to game the system. When the program began in 2009, 37 percent of nursing homes received four-or-five-star ratings. In 2013, nearly half did.
One way homes are inflating scores is through the staffing criteria. Nursing homes get an extra star if they score a four or five in staffing levels. The staff rating is based on a form that a home completes once a year at the time of annual inspection. Homes add workers in the period leading up to inspection to get the extra star.
The quality measure is also not checked by Medicare, and is based on data collected by the home about every patient, such as whether bedridden or wheelchair patients are developing bedsores and how many residents experience serious falls.
Federal officials acknowledged that the quality measures rating needed improvement and said they were testing an auditing program.
Patient groups' consider the ratings so inflated that they no longer support their use and have found them helpful in only weeding out the worst-performing homes.
"They've given a false sense of security to the public," said Carole Herman, president of the Foundation Aiding the Elderly, in Sacramento.