Most of the nursing homes in New Mexico accept patients who are on either Medicaid or Medicare, which are both federal health insurance programs. In fact, many of these patients must use one or both programs to survive financially.
Because these nursing homes are getting access to money through a federal program, the government has the right to enforce certain rules, specifically safety and care standards, as a condition of these facilities continuing to get federal funds. While some of these rules are technical in nature, many if not most of them serve to protect patients from nursing home abuse or neglect.
There are enforcement mechanisms in place designed to hold nursing homes accountable to these rules. These mechanisms include the use of surprise inspections. These inspections are supposed to occur in an interval between one year and 15 months. However, the exact timing of the inspections is designed to be unpredictable. Additionally, other non-routine inspections, like after the regulator receives a complaint, are possible.
After these inspections, the authorities may impose fines on the home for what it sees as relatively minor or sporadic violations. For more serious issues, the home could lose its right to bill Medicare or Medicaid for services either permanently or for a period of time.
The good news is that the state can impose these penalties for unsafe practices even when no one gets hurt. The bad news, if there is any, is that if a patient has been injured on account of a violation, the state can’t be the one to give the victim or the victim’s family compensation. Instead, the victim must have a personal injury lawsuit filed in his or her behalf. Still, the fact that a nursing home got penalized for violating a safety regulation can be valuable information to have when prosecuting one’s own claim against a nursing home.