Nearly Half of Nursing Home Falls Go Unreported, Per HHS Inspector General

Privately owned facilities, franchise chains and nursing homes with more than 160 beds were significantly more likely to underreport falls.

A federal watchdog agency reports that many U.S. nursing homes are failing to accurately report resident falls, distorting government quality ratings.

According to findings published in the Department of Health and Human Services Office of Inspector General (OIG) Medicare nursing home fall report for September 2025, major falls go unreported in 43% of facilities, with the highest rates of underreporting found in for-profit and chain-operated nursing homes.

The OIG is an independent government agency providing oversight to the Centers for Medicare & Medicaid Services (CMS) and other federal health programs. Its investigations help identify gaps in care, fraud and regulatory noncompliance across facilities receiving federal funding.

OIG Nursing Home Data

The current OIG report analyzed CMS claims data, fall and injury assessments, and hospital discharge records from July 2022 through June 2023, to determine whether nursing home falls were properly reported and whether they resulted in major injuries or hospitalizations.

Over the one-year study period, nearly 43,000 falls were documented, with close to 2,000 residents dying during hospitalization following a fall. On average, 3.4% of long-stay nursing home residents nationwide experienced a fall that resulted in a serious injury.

However, the data suggest these figures likely underestimate the true scope of the problem, as 43 percent of major falls were not reported by nursing homes. Underreporting was most common in for-profit facilities, chain-operated homes, and those with more than 160 beds, with about 45 percent of those facilities failing to report major falls.

Nursing homes with a higher star rating on the CMS Care Compare rating site had lower fall rates overall. Similarly, those with more registered nurses on staff also had lower fall rates.

The data indicated serious falls were four times more likely among short stay residents compared to long stay residents, since short stay residents tend to be more mobile than long stay residents.

Nursing home fall underreporting varied by state and resident characteristics. In more rural areas, there were 25% lower fall rates. This includes states such as Vermont, South Dakota and North Dakota.

Overall, researchers said nursing home falls are largely underreported to CMS, which may impact the quality of data provided by the Care Compare website.

Millions of people rely on the Care Compare website to evaluate nursing home quality and safety for their loved ones. However, the OIG report indicates that low fall rates on Care Compare are more likely driven by a failure to report to avoid low quality scores, not actual low fall rates.

The investigation did not examine how or why underreporting occurred, but noted that in some cases, facilities may have withheld information to avoid negatively affecting their quality ratings.

The OIG determined it is necessary to implement fall prevention programs in nursing homes. Even though not all falls can be prevented, the programs are shown to be effective at reducing the risk of falls and serious injuries.

The CMS says it is working on retooling nursing home reporting to improve the accuracy of assessments, and the OIG also highlighted a need for facilities to implement quality improvement initiatives that address fall prevention.

Nursing Home Concerns

The findings of the report echo data revealed in prior CMS reports, which have warned that nursing home injuries like bedsores and nursing home falls are often underreported by long-term care facilities. The research concluded that hospitalizations from fall injuries were underreported by 40%.

Other studies have indicated simple techniques like routine exercise can help prevent fall and fracture injuries in nursing homes and elderly care facilities by more than 16%.

Additionally, there are growing concerns that hospitals and nursing homes bought by private equity firms often face a decreased ability to serve patients, resulting in more falls and injuries.

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