OIG Report: Nursing Homes Inappropriately Diagnosed Residents With Schizophrenia To Mask Misuse Of Antipsychotic Drugs

In its March 2026 report entitled “Nursing Homes Inappropriately Diagnosed Residents with Schizophrenia to Mask the Misuse of Antipsychotic Drugs,” the Office of Inspector General (OIG) of the Department of Health and Human Services stated:

Why OIG Did This Review

• The misuse of antipsychotic drugs in nursing homes has been a longstanding concern, particularly
  because these drugs can have a sedative effect and might be used as chemical restraints to control
  residents’ behavior. In addition, antipsychotic drugs pose an increased risk of death for elderly
  patients with dementia.
• In response to concerns about misuse, CMS developed a quality measure—the percentage of residents
  given antipsychotic drugs—to track use of antipsychotic drugs in nursing homes. This quality measure
  factors into a nursing home’s star rating.
• Residents who have been diagnosed with schizophrenia are not counted toward the quality measure.
  As a result, nursing homes have an incentive to inappropriately diagnose residents with schizophrenia.
• This is the second in a two-part series assessing antipsychotic drug use in nursing homes.

What OIG Found

OIG’s comprehensive review of 40 nursing home inspections completed by CMS found instances of nursing
homes inappropriately diagnosing residents with schizophrenia. Specifically, our review of these inspections
found instances in which:
Nursing homes inappropriately diagnosed residents with schizophrenia to mask the nursing homes’
misuse of antipsychotic drugs and to artificially inflate their star ratings.
Medical directors made inappropriate schizophrenia diagnoses to justify prescribing antipsychotic
drugs.
Nursing homes also used inappropriate schizophrenia diagnoses to skirt Medicare safeguards
intended to protect residents.
By inappropriately diagnosing schizophrenia, nursing homes compromised residents’ care.

What OIG Recommends

OIG recommends that CMS:

1. Build on its efforts to reduce inappropriate schizophrenia diagnoses in nursing homes.
2. Expand its use of data to monitor nursing homes’ use of schizophrenia diagnoses and target
   oversight.
3. Increase efforts to ensure that nursing home residents and their families are fully informed when
   antipsychotic drugs are given.
   CMS did not explicitly concur or nonconcur with our three recommendations. We encourage CMS to reexamine its position on concurrence in its Final Management Decision.

“Nursing homes added schizophrenia diagnoses to records of residents who were given antipsychotic drugs, not because the residents showed symptoms of schizophrenia, but because the nursing homes wanted to improve their star ratings.”

Source

If you or a loved one may have been injured (or worse) in a nursing home in the United States due to misuse of antipsychotic drugs, nursing home staff shortage, nursing home understaffing, nursing home pressure ulcer (nursing home bedsore) negligence, a nursing home infection, nursing home fall, nursing home aspiration, nursing home neglect, nursing home negligence, nursing home abuse, or the nursing home failing to properly care for a vulnerable adult, you should promptly find a nursing home malpractice lawyer who may investigate your nursing home malpractice claim for you and represent you or your loved one in a nursing home malpractice case, if appropriate.

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