The GAO has issued a report entitled “Nursing Homes: Complexity of Private Investment Purchases Demonstrates Need for CMS to Improve the Usability and Completeness of Ownership Data.” The GAO identified private investment (PI) ownership using a proprietary database and analyzed data from six PI firms about their interest and involvement in nursing homes. The GAO found that 1,876 unique nursing homes were acquired by PI firms from 1998 through 2008, in some cases involving entire nursing home chains (both the operations and any owned real estate) and others involving only the real estate. Ten PI firms accounted for 89 percent of the nursing homes acquired by PI firms during this period. Of the six PI firms from which GAO collected information, those that acquired a chain reported being more involved in nursing home operations than those that only acquired the real estate. According to GAO, PECOS provided a confusing picture of the complex ownership structures and chain affiliations of the six PI-owned nursing home chains, since it did not provide any indication of the relationships among the numerous organizational owners listed for PI-owned nursing homes and since PI ownership was often not readily apparent. Moreover, CMS’s ability to determine the accuracy and completeness of the reported ownership data is limited. The GAO also found that HHS has made limited use of PECOS ownership data, and tracking compliance problems among commonly-owned homes or multistate chains can be ad hoc. In light of interest by state officials and others expressed in nationwide ownership data to improve nursing home oversight, CMS has established a workgroup to consider whether and how to provide PECOS access to external parties such as states. According to GAO, the implementation of the Patient Protection and Affordable Care Act provides CMS with an opportunity to address shortcomings in the current PECOS database and to make ownership information available to states and consumers in a more intelligible way. The report includes 11 recommendations designed to strengthen reporting requirements to make nursing home ownership structures more understandable and improve the accuracy and dissemination of these data. HHS concurred with all of GAO’s recommendations.