Nursing homes inappropriately diagnosed residents with schizophrenia and administered antipsychotic drugs to manage behavior — in some cases for the benefit of staff — according to two March 2026 reports from the HHS Office of Inspector General.
Both reports are based on a review of 40 nursing home inspections completed by CMS. In one issue brief, inspectors identified cases in which facilities added schizophrenia diagnoses to exclude residents from a quality measure tracking antipsychotic drug use, which factors into CMS star ratings.
That report also found medical directors made inappropriate schizophrenia diagnoses to justify prescribing antipsychotic drugs, and some facilities use those diagnoses to skirt Medicare safeguards intended to protect residents. The practice compromised resident care, including cases in which patients did not receive appropriate evaluations or treatment for underlying conditions.
The OIG recommended that CMS reduce inappropriate schizophrenia diagnosis, target oversight, increase use of data to monitor schizophrenia diagnoses and ensure residents and families are fully informed when antipsychotic drugs are prescribed.
In a separate report, the OIG found nursing homes administered antipsychotic drugs to residents with dementia to manage behavior — sometimes for staff convenience — despite FDA warnings that the drugs may increase risk of death. Facilities also did not take required steps to protect residents from receiving medications.
Medical directors did not consistently fulfill their oversight responsibilities, according to the report. Medical directors failed to prevent inappropriate prescribing, while pharmacists did not identify concerns or recommend dose reductions. The OIG also cited inadequate policies and procedures, which undermine safeguards intended to protect residents.
The OIG recommended that CMS further develop resources, increase transparency, ensure medical directors fulfill their role and help improve policy and procedures.
