CMS's Reliance on Puerto Rico's Certification Surveys Could Not Ensure the Safety of Medicare Beneficiaries Who Received Home Health Care Services Provided by St. Luke's Home Health Agency - Juana Diaz

CMS's reliance on the Puerto Rico Department of Health's (health department) certification surveys of St. Luke's Home Health Agency-Juana Diaz (Juana Diaz) could not fully ensure the safety of Medicare beneficiaries. Specifically, none of the 43 Juana Diaz employees had a certification from the Puerto Rico Police indicating that he or she was not a registered sex offender. Juana Diaz officials stated that the home health agency (HHA) had not established procedures for requiring employees to obtain certification that they were not registered sex offenders because HHA officials were not aware of the Commonwealth requirement.

The health department's survey unit conducted a validation survey of Juana Diaz on July 21, 2010; however, surveyors did not determine whether Juana Diaz had verified the sex offender status of its employees. According to survey unit officials, this occurred because the health department never issued the survey unit an administrative order regarding how the unit should review compliance with Commonwealth requirements for verifying HHA workers' sex offender status. Consequently, the survey unit did not review compliance with these requirements in any of its surveys of HHAs in Puerto Rico.

Health department officials acknowledged that this occurred because the department did not have procedures for periodically reviewing the enacted Commonwealth laws. Therefore, an administrative order was not created in a timely manner to require the survey unit to incorporate compliance with sex offender registration requirements in the certification surveys.

To improve protection provided to Medicare beneficiaries receiving home health services, we recommended that CMS work with the Community Health Accreditation Program and the health department to ensure that Juana Diaz and other HHAs meet Commonwealth requirements for ensuring that their employees are not registered sex offenders. The health department described steps it has taken since our draft report to ensure that HHAs throughout Puerto Rico request sex offender reports for their employees. CMS concurred with our recommendation and indicated that it would review our findings to determine whether it should request that the health department examine Juana Diaz's practices.