Individuals with Allegations

Federal reporting rules require nursing homes to report allegations of mistreatment, neglect or abuse (including injuries of unknown origin) and misappropriation of resident property made against any employee or contracted staff - licensed or unlicensed - providing services for nursing home residents to Health Care Personnel Investigations.

State statutes require health care facilities to report allegations involving any unlicensed staff that has direct access to residents, clients, or their property to Health Care Personnel Investigations. Direct access includes any facility unlicensed staff (including contracted staff) that during the course of employment has the opportunity for direct contact with an individual or an individual's property, when that individual is a resident or person to whom services are provided.

Allegations

Allegation reports are reviewed and screened to determine if Health Care Personnel Investigations will conduct an investigation of the reported allegation. Additional information may be requested from the reporting health care facility.

A decision to investigate an allegation results in a "pending" (pending allegation investigation) listing entered on the Health Care Personnel Registry (HCPR) with the accused individual's name. A certified letter of notification is mailed to the accused individual.  The letter includes notice of the investigation and due process rights available. The "pending" listing remains on the HCPR until the allegation is either unsubstantiated or a substantiated finding is listed on the Health Care Personnel Registry.

The accused individual should keep Health Care Personnel Investigations apprised of any address changes during or after investigations to assure delivery of any letters or notifications from our office. The individual should contact our office by telephone at 919-855-3968 to notify us of any address changes.

During investigations of allegations, investigators gather evidence to determine whether an allegation is substantiated or unsubstantiated. In some cases, a local law enforcement agency or the Medicaid Investigations Division of the Department of Justice may conduct an investigation as well. Investigations may include on-site visits, records reviews, and interviews with victims, accused individuals, witnesses, and other individuals.

If the allegation is unsubstantiated, the "pending" listing is removed from the Health Care Personnel Registry.

If the allegation is substantiated, the accused is notified by certified letter of the intent to enter a finding on the Health Care Personnel Registry. If the allegation was of abuse, neglect, or misappropriation of the property of a nursing home resident, the notification includes that the finding will also be entered onto the Nurse Aide I Registry. The notification contains information about the due process rights that are available to the individual.

Substantiated Findings

Accused individuals with substantiated allegations have due process rights available to them. A substantiated finding is not listed until after the completion of a 30-days opportunity to file a petition for a contested case hearing with the Office of Administrative Hearings.

If the accused individual does file a petition for a contested case hearing, the listing of the finding is postponed until after an Administrative Law Judge hears the case and makes the final decision.

If the accused individual does not exercise his/her due process rights by filing a petition for a contested case hearing with the Office of Administrative Hearings, the substantiated finding is listed.

After a finding is listed on the Health Care Personnel Registry (and, if applicable, the Nurse Aide I Registry), the specific allegation, the evidence summary, the date of the hearing (if the individual chose to have one) and the outcome are available to an inquirer. If the individual chooses to make a rebuttal statement, it is also included with the registry listing and provided to inquirers.

If any substantiated allegation meets certain criteria, it will be reported to the National Healthcare Integrity and Protection Data Bank.

Rebuttal Statements

If an individual wishes to have a rebuttal statement entered on the registry(ies), they may prepare such a statement and send it to this office. The Department reserves the right to edit any rebuttal statement solely for purposes of assuring that the statement is brief enough to fit into the space provided by the registry. In order to avoid editing of a rebuttal statement, you are encouraged to keep any such statement to 200 words in length.

Appeal Rights

Individuals have the following appeal rights:

To appeal, the individual needs to file a petition for a contested case hearing with the Office of Administrative Hearings within 30 days after the mailing of the letter notifying the individual of "Pending" listing, the substantiated finding and/or the decision to not remove the Neglect finding on the registry(ies).

If an individual properly files a petition to contest the "pending" listing of the allegation on the Health Care Personnel Registry and you have a case already pending in the Office of Administrative Hearings, individuals do not need to file another petition to appeal the entry of the substantiated finding on the Health Care Personnel Registry. However, if the individual did not file a petition to contest the "pending" listing of the allegation on the Health Care Personnel Registry or if the petition to contest the listing of the "pending" allegation on the Health Care Personnel Registry was not properly filed and has either been dismissed or was not accepted by the Office of Administrative Hearings, the individual will need to file a petition to appeal the entry of the substantiated finding on the Health Care Personnel Registry.

When filing a petition for a contested case hearing, please list the Department of Health and Human Services, Division of Health Service Regulation as the Respondent. Please write at the top of your petition:  THIS IS A HEALTH CARE PERSONNEL REGISTRY CASE. Failure to do so will result in a twenty dollar processing fee. For complete instructions on the filing of petitions, please contact the Office of Administrative Hearings at 1711 New Hope Church Road in Raleigh, telephone number 919-431-3000.  The mailing address for the Office of Administrative Hearings is:

Office of Administrative Hearings
6714 Mail Service Center
Raleigh, North Carolina  227699-6714

In addition, when filing a petition for a contested case hearing, the individual must also serve a copy of the petition on all other parties, which includes the Department of Health and Human Services. The Department's representative for such service is Ms. Emery Edwards Milliken, General Counsel. This person may receive service of process by mail at the following address:

Ms. Lisa G. Corbett
Department of Health and Human Services
Office of Legal Affairs
2005 Mail Service Center
Raleigh, North Carolina 27699-2005

Individuals also have the right to be represented by an attorney at their own expense.

In addition to the right to file a petition for contested case hearing, North Carolina Statute 150B-22 encourages the settlement of disputes through informal procedures. In keeping with this law, this office is available for discussion or other informal procedures to assist in resolving any dispute individuals may have with our findings and actions.

If an individual does not file a petition to contest the "pending" listing of the allegation on the Health Care Personnel Registry and the individual does not file a petition for a contested case hearing within the thirty day period allowed for contesting the entry of the substantiated finding, the individual will lose their right to appeal. Failure to appeal will result in the information being permanently placed on the registry.

Request for Neglect Removal

An individual with a substantiated Resident Neglect Finding listed on the Health Care Personnel Registry or Nurse Aide Registry will not become eligible for removal until one year after the finding has been listed on the registry(ies). The individual may petition the Department to remove the listed Finding of Resident neglect one year after the finding has been listed on the registry(ies). The petition (a written request in any format) must be received by Health Care Personnel Investigations (HCPI) from the individual with the listed Resident Neglect finding or his/her legal representative to initiate the process.

Neglect Removal may only be considered if the neglect involved in the original finding was a singular occurrence and there were no other substantiated findings of any type listed against this individual. Documents such as work history, current state-wide criminal background check and letters of reference will be requested from the individual to help determine if there is or is not a pattern of abusive/neglectful behavior in the individual's employment or personal history. 

If all the requested documents are not received from the individual within 90 calendar days from the date on the letter from Health Care Personnel Investigations, the case will be closed and the individual will be mailed a Closed/Inactive Case Letter. 

Determinations of whether to remove a Resident Neglect Finding will be made within the allowances under 42 U.S.C. 1395i-3(g)(1)(D)(ii) and N.C. General Statute §131E-256(i)(i1)(j).

Anyone with questions about Neglect Removal may contact our office by telephone at 919-855-3968.

References