Two reports issued by the US Department of Health and Human Services Office of Inspector General (OIG) and posted on March 19, 2026, examine the use of antipsychotic drugs in nursing homes and identify ongoing concerns related to resident safety, prescribing practices, and oversight. The reports make up a two-part series examining concerns related to the inappropriate use of antipsychotic medications in nursing homes, with a particular focus on residents with dementia.
The first report found instances in which nursing homes administered antipsychotic drugs to residents with dementia to manage behaviors, despite warnings from the US Food and Drug Administration (FDA) that such use may increase the risk of death. The review, which analyzed 40 focused inspections conducted by the Centers for Medicare & Medicaid Services (CMS), also identified gaps in required safeguards. These included failures by medical directors to prevent inappropriate use, limited pharmacist intervention in identifying medication-related concerns or recommending dose reductions, and weaknesses in facility policies and procedures intended to protect residents.
The second report identified cases in which nursing homes inappropriately diagnosed residents with schizophrenia. According to the OIG, these diagnoses were used in some instances to justify the use of antipsychotic drugs and to exclude residents from a CMS quality measure that tracks antipsychotic use. Because this measure affects a facility’s Five-Star Quality Rating System, the report noted that inaccurate diagnoses may impact publicly reported quality data. The findings also indicated that inappropriate diagnoses were used to bypass certain Medicare safeguards and, in some cases, were made or supported by medical directors.
Across both reports, the OIG highlighted concerns related to oversight, documentation, and adherence to established requirements. The findings indicate:
- Antipsychotic drugs were used for behavior management in residents with dementia despite known risks.
- Required monitoring and safeguards were not consistently implemented.
- Medical directors and pharmacists did not consistently fulfill their roles in overseeing appropriate medication use.
- Facility policies and procedures did not always support effective controls.
- Inaccurate schizophrenia diagnoses were used to justify antipsychotic use and affect quality reporting.
The OIG made several recommendations to CMS, including improving resources and transparency related to antipsychotic drug use, strengthening oversight of medical directors and pharmacists, enhancing monitoring of schizophrenia diagnoses, and supporting improvements in facility-level policies and procedures. CMS did not fully concur with all recommendations and was encouraged to further evaluate its position as part of the final management decision process.
Here are the links to access the full reports: Nursing Homes’ Inappropriate Use of Antipsychotic Drugs Poses a Risk to Residents and Nursing Homes Inappropriately Diagnosed Residents with Schizophrenia to Mask the Misuse of Antipsychotic Drugs.
Compliance Perspective
Issue
Two recent reports from the OIG highlight ongoing concerns related to the use of antipsychotic medications in nursing homes, particularly among residents with dementia. The findings point to challenges in ensuring appropriate prescribing, accurate diagnoses, and consistent oversight of medication use. The reports also identified gaps in clinical oversight and facility-level controls that are intended to safeguard residents and support compliance with federal requirements established by CMS and guidance from the FDA.
Discussion Points
- Review and update policies and procedures related to antipsychotic medication use, including prescribing practices, behavioral interventions, documentation requirements, and diagnostic criteria. Policies should align with federal requirements and clinical guidelines, clearly define the roles of the interdisciplinary team, and include safeguards to prevent inappropriate use. Facilities may also consider utilizing external consultants to perform targeted reviews or mock surveys to evaluate current practices and identify potential compliance risks.
- Provide education and training to clinical and interdisciplinary staff on appropriate use of antipsychotic medications, nonpharmacological interventions for behavior management, and accurate diagnostic practices. Training should reinforce the risks associated with antipsychotic use in residents with dementia, documentation expectations, and the importance of individualized care planning. Med-Net Academy’s course, Understanding the 5-Star Rating Program, provides a comprehensive overview of the rating system, including the three performance domains, health inspection scores, deficiencies, missing data, staffing ratings, scoring exceptions, and factors that can raise or lower a facility’s rating.
- Conduct routine audits of antipsychotic medication use, including prescribing patterns, indications for use, dose reductions, and supporting documentation. Audits should also evaluate the accuracy of diagnoses, including schizophrenia, and ensure compliance with quality reporting requirements. Facilities may benefit from incorporating these reviews into their QAPI processes and engaging a third-party reviewer to provide an objective assessment and assist with corrective action planning where needed.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*