Failure to Provide Timely, Reasonably Priced Access to Medical Records
Penalty
Summary
The deficiency involves the facility’s failure to provide a resident’s medical records in a timely manner and at a reasonable cost, as required by regulation and the facility’s own policy. The facility policy on Release of Information, revised November 2009, states that residents may obtain photocopies of their records with at least 48 hours’ notice (excluding weekends and holidays), and that a fee may be charged for copying services. For one resident, a written, HIPAA-compliant authorization signed by the resident’s Power of Attorney was submitted on October 13, 2025. The facility generated an invoice on October 23, 2025, billing $732.08 for 1,424 pages of records. The Director of Medical Records (Employee E12) stated that the resident’s son was told he would have to pay this amount to receive the records, in accordance with facility policy, and that he declined to pay. A subsequent written request for “any and all records” with a HIPAA-compliant authorization, dated January 3, 2026, was submitted through a third party on behalf of the resident. On February 9, 2026, that party emailed Employee E12, warning that regulatory agencies would be notified if the records were not provided without further delay. E12 responded on February 10, 2026, that the records would be prepared that week, and later reported that the resident’s son picked up a paper copy on February 17, 2026. On February 22, 2026, the requesting party reported that the resident had requested an electronic version via an electronic form but instead received an incomplete paper copy missing multiple important parts of the chart, and requested a PDF copy of the PCC chart. E12 replied on February 25, 2026, that the missing records would be provided as soon as possible, and on March 3, 2026, stated that MDS documents and nine more months of CNA flow sheets were still being compiled and would be scanned by the end of the week. By March 10, 2026, the requester was still following up, and on March 19, 2026, E12 stated she had been printing and scanning as fast as she could and did not know how to send the chart electronically. The Nursing Home Administrator confirmed that records can be sent electronically via a link and confirmed that the resident’s records were not released upon request in a timely manner or at a reasonable cost.
We Help Long-Term Care Teams Stay Survey-Ready
We process and analyze inspection reports and plan of correction using AI to extract insights and trends so providers can improve care quality and stay ahead of compliance risks.