Fla. man presumed dead after sinkhole opens under his bed

SEFFNER, Fla. A man was missing and feared dead early Friday after a large sinkhole opened under the bedroom of a house near Tampa.

Jeff Bush is presumed dead after a sinkhole opened under his bed.

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CBS

His brother says Jeff Bush screamed for help before he disappeared.

The 36-year-old man's brother, Jeremy Bush, told rescue crews he heard a loud crash around 11 p.m. Thursday, then heard his brother screaming for help.

"When he got there, there was no bedroom left," Hillsborough County Fire Rescue spokeswoman Jessica Damico said. "There was no furniture. All he saw was a piece of the mattress sticking up."

Jeremy Bush called 911 and frantically tried to help his brother Jeff. He said he jumped into the hole and dirt was quickly up to his neck.

"The floor was still giving in and the dirt was still going down, but I didn't care. I wanted to save my brother," Jeremy said. "But I just couldn't do nothing."

An arriving deputy pulled Jeremy Bush from the still-collapsing house.

28 Photos

Sinkholes

"I reached down and was able to actually able to get him by his hand and pull him out of the hole," Hillsborough County Sheriff's Deputy Douglas Duvall said. "The hole was collapsing. At that time, we left the house."

Engineers worked to determine the size of the sinkhole. At the surface, officials estimated it was about 30 feet across. Below the surface, officials believed it was 100 feet wide.

"The entire house is on the sinkhole," Damico said.

Hillsborough County Fire Chief Ron Rogers told a news briefing that extra-sensitive listening devices and cameras were inserted into the sinkhole. "They did not detect any signs of life," he said.

By early Friday, Hillsborough County Fire Rescue officials determined the home had become too unstable to continue rescue efforts.

Neighbors on both sides of the home have been evacuated.

Sinkholes are common in seaside Florida, whose underlying limestone and dolomite can be worn away by water and chemicals, then collapse.

Engineers condemned the house, reports CBS Tampa affiliate WTSP.

From the outside of the small, sky blue house, nothing appeared wrong. There wear no cracks and the only sign something was amiss was the yellow caution tape circling the house.

Hillsborough County Sheriff's Office spokesman Larry McKinnon said authorities asked sinkhole and engineering experts, and they were using equipment to see if the ground can support the weight of heavy machinery needed for the recovery effort.

Jeremy Bush stood in a neighbor's yard across the street from the house Friday and recounted the harrowing collapse.

"He was screaming my name. I could swear I heard him hollering my name to help him," he said of his brother Jeff.

Jeremy Bush's wife and his 2-year-old daughter were also inside the house. "She keeps asking where her Uncle Jeff is," he said. "I lost everything. I work so hard to support my wife and kid and I lost everything."

Janell Wheeler told the Tampa Bay Times newspaper she was inside the house with four other adults and a child when the sinkhole opened.

"It sounded like a car hit my house," she said.

The rest of the family went to a hotel but she stayed behind, sleeping in her car.

"I just want my nephew," she said through tears.

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Obama Signs Order to Begin Sequester Cuts

President Obama and congressional leaders today failed to reach a breakthrough to avert a sweeping package of automatic spending cuts, setting into motion $85 billion of across-the-board belt-tightening that neither had wanted to see.

President Obama officially initiated the cuts with an order to agencies Friday evening.

He had met for just over an hour at the White House Friday morning with Republican leaders House Speaker John Boehner and Senate Minority Leader Mitch McConnell and his Democratic allies, House Minority Leader Nancy Pelosi, Senate Majority Leader Harry Reid and Vice President Joe Biden.

But the parties emerged from their first face-to-face meeting of the year resigned to see the cuts take hold at midnight.

"This is not a win for anybody," Obama lamented in a statement to reporters after the meeting. "This is a loss for the American people."

READ MORE: 6 Questions (and Answers) About the Sequester

Officials have said the spending reductions immediately take effect Saturday but that the pain from reduced government services and furloughs of tens of thousands of federal employees would be felt gradually in the weeks ahead.

Sequestration Deadline: Obama Meets With Leaders Watch Video

Sequester Countdown: The Reality of Budget Cuts Watch Video

Federal agencies, including Homeland Security, the Pentagon, Internal Revenue Service and the Department of Education, have all prepared to notify employees that they will have to take one unpaid day off per week through the end of the year.

The staffing trims could slow many government services, including airport screenings, air traffic control, and law enforcement investigations and prosecutions. Spending on education programs and health services for low-income families will also get clipped.

"It is absolutely true that this is not going to precipitate the crisis" that would have been caused by the so-called fiscal cliff, Obama said. "But people are going to be hurt. The economy will not grow as quickly as it would have. Unemployment will not go down as quickly as it would have. And there are lives behind that. And it's real."

The sticking point in the debate over the automatic cuts -- known as sequester -- has remained the same between the parties for more than a year since the cuts were first proposed: whether to include more new tax revenue in a broad deficit reduction plan.

The White House insists there must be higher tax revenue, through elimination of tax loopholes and deductions that benefit wealthier Americans and corporations. Republicans seek an approach of spending cuts only, with an emphasis on entitlement programs. It's a deep divide that both sides have proven unable to bridge.

"This discussion about revenue, in my view, is over," Boehner told reporters after the meeting. "It's about taking on the spending problem here in Washington."

Boehner: No New Taxes to Avert Sequester

Boehner says any elimination of tax loopholes or deductions should be part of a broader tax code overhaul aimed at lowering rates overall, not to offset spending cuts in the sequester.

Obama countered today that he's willing to "take on the problem where it exists, on entitlements, and do some things that my own party doesn't like."

But he says Republicans must be willing to eliminate some tax loopholes as part of a deal.

"They refuse to budge on closing a single wasteful loophole to help reduce the deficit," Obama said. "We can and must replace these cuts with a more balanced approach that asks something from everybody."

Can anything more be done by either side to reach a middle ground?

The president today claimed he's done all he can. "I am not a dictator, I'm the president," Obama said.

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Italy's lefti-wing leader suggests loose alliance to end deadlock

ROME: Italian left-wing leader Pier Luigi Bersani on Friday held out the prospect of forming a minority government based on a loose alliance in parliament following inconclusive elections, as Europe puts on pressure for a quick solution.

"I am calling it a government of change, which I would take the responsibility of leading," the Democratic Party leader said in an interview with La Repubblica daily, warning that Italy's "governability (is) at risk".

"Like all governments, it will ask for the confidence of parliament," he said.

But Bersani rejected out of hand the possibility of a grand coalition arrangement with Silvio Berlusconi's centre-right forces, after a new anti-establishment party upset the traditional balance of power between Italy's right and left by winning big in the polls early this week.

Bersani said the government he is proposing would have key objectives, including easing austerity measures, creating jobs, helping the poorest and cutting government costs -- echoing at least some of the demands made by the anti-establishment Five Star Movement.

But since a Democratic Party-led coalition did not manage majorities in both houses of parliament, the new government would depend on the support of other parties in the upper house -- an arrangement that analysts have warned would prove "highly unstable" at a time when Italy is facing an acute economic crisis.

Stefano Folli, editorialist for Il Sole 24 Ore business daily, said it would "hand over the government" to the whims of the populist Five Star Movement.

Most analysts say there will have to be new elections within months to resolve the impasse.

It is unclear whether the Five Star Movement would support Bersani after its leader, former comedian Beppe Grillo, said his movement "is not going to give a vote of confidence to the Democratic Party or to anyone else".

Not everyone in his movement agrees with this rejection, however.

The party captured a quarter of the vote with a campaign that mixed advocacy on environmental causes and grassroots local issues with a crusade against political sleaze, drawing many austerity-weary Italians to its ranks.

The party has spooked Europe with its promise to hold a referendum on the euro and cancel Italy's debts, prompting European leaders to urge Italy to stick to its fiscal commitments and form a government as soon as possible.

A deputy from German Chancellor Angela Merkel's Christian Democratic Union (CDU) called on Friday for Italy to leave the euro if it could not stick to EU rules after its inconclusive election.

"If one can't succeed in persuading the people of a country that they have to stick to the commitments they have themselves signed up to in terms of how the common currency works, then you can't demand new elections from outside, but the country must return to its own currency," said Klaus-Peter Willsch.

Markets were jittery in trading on Friday, with the Milan index plunging 1.58 percent -- the worst performer among major European stock markets.

The technocratic cabinet of outgoing premier Mario Monti, who won praise abroad for his budget discipline and economic reforms but became increasingly unpopular at home, will stay in place until a new government is formed.

A centrist coalition led by Monti came in fourth place, garnering far too little support to be able to cobble a majority in alliance with the left.

Bersani meanwhile ruled out another possibility -- the formation of an emergency coalition with his long-time arch-rival Berlusconi -- saying: "The hypothesis of a grand understanding does not exist and will never exist".

The scandal-tainted Berlusconi on Friday made an appearance at his appeal trial in Milan against a tax fraud conviction linked to his business empire.

A verdict in the case is expected later this month, along with a ruling in another trial in which Berlusconi is a defendant on charges of having sex with an underage prostitute and abuse of office while he was still prime minister.

Italy's new parliament must convene by March 15 at the latest under the rules of the constitution. After parliament meets, formal negotiations can begin with Italian President Giorgio Napolitano on a new government.

Guglielmo Meardi, a professor at Warwick Business School in Britain, said Italy was "used to parliamentary instability... and should stay on the rails until the autumn, when fresh elections could be held."

- AFP/al

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Crave giveaway: Two leather iPad cases from Kavaj

Congrats to Gene W. of Highlands, Texas, for winning a Kanex Sydnee four-port recharging station in last week's giveaway. Is your iPad in need of a new outfit? This week's prize is for you.

We're giving away two sleek
iPad cases from Kavaj, a purveyor of leather gadget jackets started by two former employees of Amazon in Germany. The winner gets one Berlin case in black that fits the
iPad 2,
iPad 3, and iPad 4, and one Berlin case in brown for the iPad Mini. Both slender, supple jackets boast a classic minimalist style and can be reconfigured into two positions -- slightly angled up for interaction, and standing for movies and presentations.

They also have magnetic closures that maintain the iPad's sleep and wake functionality when the case is closed and opened.

Normally, these two cases would cost you $95, but you have the chance to get them for free. How do you go about doing that? There are a few rules, so please read carefully.

• Register as a CNET user. Go to the top of this page and hit the Join CNET link to start the registration process. If you're already registered, there's no need to register again.


• Leave a comment below. You can leave whatever comment you want. If it's funny or insightful, it won't help you win, but we're trying to have fun here, so anything entertaining is appreciated.


• Leave only one comment. You may enter for this specific giveaway only once. If you enter more than one comment, you will be automatically disqualified.
  


• The winner will be chosen randomly. The winner will receive two (2) Kavaj iPad cases, with a retail value of $95.


• If you are chosen, you will be notified via e-mail. The winner must respond within three days of the end of the sweepstakes. If you do not respond within that period, another winner will be chosen.


• Entries can be submitted until Monday, March 4, at 12 p.m. ET.

And here's the disclaimer that our legal department said we had to include (sorry for the caps, but rules are rules):

NO PURCHASE NECESSARY TO ENTER OR WIN. A PURCHASE WILL NOT INCREASE YOUR CHANCES OF WINNING. YOU HAVE NOT YET WON. MUST BE LEGAL RESIDENT OF ONE OF THE 50 UNITED STATES OR D.C., 18 YEARS OLD OR AGE OF MAJORITY, WHICHEVER IS OLDER IN YOUR STATE OF RESIDENCE AT DATE OF ENTRY INTO SWEEPSTAKES. VOID IN PUERTO RICO, ALL U.S. TERRITORIES AND POSSESSIONS, AND WHERE PROHIBITED BY LAW. Sweepstakes ends at 12 p.m. ET on Monday, March 4, 2013. See official rules for details.

Good luck.

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Two U.S. sailors convicted in Okinawa rape

Updated 4:30 a.m. EST

TOKYO Two U.S. Navy sailors were convicted and sentenced to prison on Friday for raping and robbing a woman on Okinawa in a crime that outraged many on the southern Japanese island.

Seaman Christopher Browning, of Athens, Texas, and Petty Officer 3rd Class Skyler Dozierwalker, of Muskogee, Oklahoma, were found guilty by the Naha District Court of raping and robbing a woman in her 20s in a parking lot in October. Both admitted committing the crime.

Browning, 24, was sentenced to 10 years and Dozierwalker, 23, received nine years.

The case outraged many Okinawans, who have long complained of military-related crime on their island, which hosts thousands of U.S. troops. It also sparked tougher restrictions for all 50,000 U.S. military personnel in Japan, including a curfew and drinking restrictions.

Prosecutors had sought up to 12 years in prison for Browning, who they said also robbed the woman after the rape. Both men admitted their guilt, but the defense had argued that such a long sentence would be excessive.

In handing down the verdict, presiding judge Hideyuki Suzuki said the sentences were in line with the severity of the crimes, which he called "contemptible and violent."

Tensions between U.S. troops and Okinawans are endemic because of islanders' complaints of noise, the danger of accidents and crimes committed by servicemen. The rape in October came amid large protests over the U.S. military's decision to base a new kind of aircraft at an Okinawan Marine facility.

Although most crimes committed by U.S. military personnel in Japan are handled by military courts, they can be prosecuted in Japanese courts in cases that occur off base and are deemed to be particularly serious, such as murder and rape.

The sailors were temporarily deployed to Japan with their unit, the VR-59 reserve air detachment based at Joint Naval Air Station, Fort Worth, Texas. According to police, they arrived in Okinawa two days before the crime on a brief stopover and were staying in an off-base hotel. They were reportedly drinking before the rape took place.

They will serve their sentences in a Japanese prison.

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Sequestration: Surrender is in the Air

The budget ax is about to fall, and there's little lawmakers in Washington are doing to stop it.

Despite a parade of dire warnings from the White House, an $85 billion package of deep automatic spending cuts appears poised to take effect at the stroke of midnight on Friday.

The cuts – known in Washington-speak as the sequester – will hit every federal budget, from defense to education, and even the president's own staff.

On Capitol Hill, Senate Democrats and Republicans each staged votes Thursday aimed at substituting the indiscriminate across-the-board cuts with more sensible ones. Democrats also called for including new tax revenue in the mix. Both measures failed.

Lleaders on both sides publicly conceded that the effort was largely for show, with little chance the opposing chamber would embrace the other's plan. They will discuss their differences with President Obama at the White House on Friday.

"It isn't a plan at all, it's a gimmick," Senate Minority Leader Mitch McConnell, R-Ky., said today of the Democrats' legislation.

"Republicans call the plan flexibility" in how the cuts are made, said Senate Majority Leader Harry Reid. "Let's call it what it is. It is a punt."

The budget crisis is the product of a longstanding failure of Congress and the White House to compromise on plans for deficit reduction. The sequester itself, enacted in late 2011, was intended to be so unpalatable as to help force a deal.

Eric Holder Says Sequester Makes America Less Safe Watch Video

Eric Holder Sounds Sequester Alarm: Exclusive Watch Video

Sequestration: Democrats, Republicans Play Blame Game Watch Video

Republicans and Democrats, however, remain gridlocked over the issue of taxes.

Obama has mandated that any steps to offset the automatic cuts must include new tax revenue through the elimination of loopholes and deductions. House Speaker John Boehner and the GOP insist the approach should be spending cuts-only, modifying the package to make it more reasonable.

"Do we want to close loopholes? We sure do. But if we are going to do tax reform, it should focus on creating jobs, not funding more government," House Speaker John Boehner said, explaining his opposition to Obama's plan.

Boehner, McConnell, Reid and House Minority Leader Nancy Pelosi will huddle with Obama at the White House on Friday for the first face-to-face meeting of the group this year.

"There are no preconditions to a meeting like this," White House spokesman Jay Carney said today. "The immediate purpose of the meeting is to discuss the imminent sequester deadline and to avert it."

Even if the leaders reach a deal, there's almost no chance a compromise could be enacted before the deadline. Lawmakers are expected to recess later today for a long weekend in their districts.

What will be the short-term impact of the automatic cuts?

Officials say it will be a gradual, "rolling impact" with limited visible impact across the country in the first few weeks that the cuts are allowed to stand.

Over the long term, however, the Congressional Budget Office and independent economic analysts have warned sequester could lead to economic contraction and possibly a recession.

"This is going to be a big hit on the economy," Obama said Wednesday night.

"It means that you have fewer customers with money in their pockets ready to buy your goods and services. It means that the global economy will be weaker," he said. "And the worst part of it is, it's entirely unnecessary."

Both sides say that if the cuts take effect, the next best chance for a resolution could come next month when the parties need to enact a new federal budget. Government funding runs out on March 27, raising the specter of a federal shutdown if they still can't reach a deal.

"As we anticipate an across-the-board budget cuts across our land, we still expect to see your goodness prevail, O God, " Senate Chaplain Barry Black prayed on the Senate floor this morning, "and save us from ourselves."

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U.S. will give Syrian rebels medical, food aid, not arms

ROME (Reuters) - The United States will send non-lethal aid directly to Syrian rebels for the first time, Secretary of State John Kerry said on Thursday, disappointing opponents of President Bashar al-Assad who are demanding Western weapons.

More than 70,000 Syrians have been killed in a devastating conflict that began with peaceful anti-Assad protests nearly two years ago. Some 860,000 have fled abroad and several million are displaced within the country or need humanitarian assistance.

Kerry, speaking in Rome after a meeting of the mainly Western and Arab "Friends of Syria" group said his country would more than double its aid to the Syrian civilian opposition, giving it an extra $60 million to help provide security.

The United States would now "extend food and medical supplies to the opposition, including to the Syrian opposition's Supreme Military (Council)," Kerry said.

In their final statement, the Friends of Syria pledged more political and material support to the opposition Syrian National Coalition, a fractious group that has struggled to gain traction inside Syria, especially among disparate rebel forces.

Riad Seif, a coalition leader, said on the eve of the Rome talks that it would demand "qualitative military support", though another coalition official welcomed the shift in the U.S. stance.

"We move forward with a great deal of cautious optimism," said Yasser Tabbara. "We heard today a different kind of discourse," he said, adding the opposition need military and political support.

The modest U.S. policy shift may compound the frustration that had prompted the coalition to declare last week it would boycott the Rome talks. It changed its mind under U.S. pressure.

Many in the coalition say Western reluctance to arm rebels only plays into the hands of Islamist militants now widely seen as the most effective forces in the struggle to topple Assad.

However, a European diplomat held out the prospect of possible Western military support, saying the coalition and its Western and Arab backers would meet in Istanbul next week to discuss military and humanitarian support to the rebels.

MEALS READY TO EAT

Kerry's offer of medical aid and Meals Ready to Eat (MREs), the U.S. army's basic ration, fell far short of rebel demands for sophisticated anti-tank and anti-aircraft weapons to help tip the balance against Assad's mostly Russian-supplied forces.

It also stopped short of providing other forms of non-lethal assistance such as bullet-proof vests, armored personnel vehicles and military training to the insurgents.

The Rome talks were the latest evidence that the United States and its allies have no appetite for military intervention in Syria, after the withdrawal of U.S.-led troops from Iraq and the drawdown under way in Afghanistan.

The final communique called for an immediate halt to "unabated" arms supplies to Damascus by third countries, referring mostly to Assad's allies Russia and Iran.

It also said Syria must immediately stop indiscriminate bombardment of populated areas, which it described as crimes against humanity. NATO officials say Assad's military has fired ballistic missiles within Syria, which the government denies.

Human Rights Watch has reported that at least 171 civilians were killed in four Scud missile strikes last week.

The "Friends of Syria" pledged "more political and material support to the coalition as the sole legitimate representative of the Syrian people and to get more concrete assistance inside Syria", but gave no details on exactly what would be provided.

Kerry said earlier this week he would not leave the Syrian opposition "dangling in the wind" unsure of getting support.

But the White House continues to resist providing weaponry to the rebel forces, arguing there was no way to guarantee the arms might not fall into the hands of militants who might eventually use them against Western or Israeli targets.

"HUGE DEBATE"

U.S. officials have said that the U.S. Defense and State Departments, under former Secretary of Defense Leon Panetta and former Secretary of State Hillary Clinton, privately recommended that the White House arm the rebels but were overruled.

"It's a huge debate inside the administration between those that have to deal with Syria on an everyday basis, the State Department and DoD particularly, and the White House, which ... until now has vetoed any kind of outreach to the armed groups," said Andrew Tabler, senior fellow at the Washington Institute for Near East Policy, a think-tank in the U.S. capital.

The United States says it has already provided more than $50 million in non-lethal assistance such as communications gear and governance training to the civilian opposition.

A source in the Syrian coalition, however, said even the extra $60 million promised by Washington was a pittance compared to what he said was the $40 million a day in humanitarian aid needed for Syrian refugees and internally displaced persons.

The United States has provided some $365 million in humanitarian aid for Syrian refugees in countries such as Turkey, Jordan and Lebanon and for internally displaced people, channeling this money through non-governmental organizations.

More than 40,000 people a week are fleeing Syria and the total number of refugees will likely pass 1 million in less than a month, far sooner than the United Nations had forecast, a senior U.N. official told the Security Council on Wednesday.

U.N. High Commissioner for Refugees António Guterres said his agency had registered 936,000 Syrians across the Middle East and North Africa, nearly 30 times as many as in April last year.

"We expected to have 1.1 million Syrian refugees by June. If things continue to accelerate like this, it will take less than a month to reach that number," he told the 15-member council.

(Writing by Alistair Lyon; Editing by Jon Boyle)

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SingPost sets up S$10m fund to help low-wage employees

SINGAPORE: SingPost is setting up a $10 million "Inclusivity Fund", which will benefit its low-wage workers.

Over 70 per cent of the fund will go to helping the workers cope with the rising cost of living. This will include retention awards and enhancements to their wages.

Part of the fund will also go into training to help them upgrade their skills.

Staff with school-going children can also stand to benefit from bursaries and scholarships.

The fund will be disbursed over five years and benefit some 3,400 workers.

The company will also be investing about S$30 million to enhance its delivery and improve processes.

- CNA/xq

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Ubuntu Touch beats Firefox OS to win best of MWC from CNET

Ubuntu Touch has won the best of Mobile World Congress award from CNET

(Credit:
Sarah Tew/ CNET)

We've seen lots of interesting hardware at Mobile World Congress, and yesterday when the team met to talk about what product should get our best of show award, there were plenty of gadgets in the mix. Asus' Padfone Infinity was in the running, along with its FonePad, the Nokia Lumia 720 and Sony's Xperia Z tablet.

But the nine-strong judging team from our San Francisco, New York and London offices quickly discounted those products. We were much more interested in the product category that has arguably generated more buzz at MWC and is potentially much more disruptive: new mobile operating systems.

The two we zeroed in on, Mozilla's Firefox OS and Canonical's Ubuntu Touch, were hotly debated. Lots was said about the impressive number of carriers and manufacturers
Firefox OS has lined up behind it. But once put to a vote, Ubuntu Touch was the clear winner, with Firefox OS the runner-up.

The team thought that Ubuntu Touch, the
tablet version of which we got our hands-on for the first time at MWC, feels more like the complete package at this point. We liked its slick, elegant interface that makes use of every side of the screen and puts your content and contacts front and centre, minimising the time spent hopping back to a home screen.

Take a look at our hands-on video and picture galleries on this page to see what all the fuss is about, and read our first takes of both Ubuntu Touch and Firefox OS for more details on both.

Ubuntu Touch is a touch of class

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Medicare paid billions to sub-par nursing homes: HHS

SAN FRANCISCO Medicare paid billions in taxpayer dollars to nursing homes nationwide that were not meeting basic requirements to look after their residents, government investigators have found.

The report, released Thursday by the Department of Health and Human Services' inspector general, said Medicare paid about $5.1 billion for patients to stay in skilled nursing facilities that failed to meet federal quality of care rules in 2009, in some cases resulting in dangerous and neglectful conditions.

One out of every three times patients wound up in nursing homes that year, they landed in facilities that failed to follow basic care requirements laid out by the federal agency that administers Medicare, investigators estimated.

By law, nursing homes need to write up care plans specially tailored for each resident, so doctors, nurses, therapists and all other caregivers are on the same page about how to help residents reach the highest possible levels of physical, mental and psychological well-being.

Not only are residents often going without the crucial help they need, but the government could be spending taxpayer money on facilities that could endanger people's health, the report concluded. The findings come as concerns about health care quality and costs are garnering heightened attention as the Obama administration implements the nation's sweeping health care overhaul.

"These findings raise concerns about what Medicare is paying for," the report said.

Investigators estimate that in one out of five stays, patients' health problems weren't addressed in the care plans, falling far short of government directives. For example, one home made no plans to monitor a patient's use of two anti-psychotic drugs and one depression medication, even though the drugs could have serious side effects.

In other cases, residents got therapy they didn't need, which the report said was in the nursing homes' financial interest because they would be reimbursed at a higher rate by Medicare.

In one example, a patient kept getting physical and occupational therapy even though the care plan said all the health goals had been met, the report said.

The Office of Inspector General's report was based on medical records from 190 patient visits to nursing homes in 42 states that lasted at least three weeks, which investigators said gave them a statistically valid sample of Medicare beneficiaries' experiences in skilled nursing facilities.

That sample represents about 1.1 million patient visits to nursing homes nationwide in 2009, the most recent year for which data was available, according to the review.

Overall, the review raises questions about whether the system is allowing homes to get paid for poor quality services that may be harming residents, investigators said, and recommended that the Centers for Medicare & Medicaid Services tie payments to homes' abilities to meet basic care requirements. The report also recommended that the agency strengthen its regulations and ramp up its oversight. The review did not name individual homes, nor did it estimate the number of patients who had been mistreated, but instead looked at the overall number of stays in which problems arose.

In response, the agency agreed that it should consider tying Medicare reimbursements to homes' provision of good care. CMS also said in written comments that it is reviewing its own regulations to improve enforcement at the homes.

"Medicare has made significant changes to the way we pay providers thanks to the health care law, to reward better quality care," Medicare spokesman Brian Cook said in a statement to The Associated Press. "We are taking steps to make sure these facilities have the resources to improve the quality of their care, and make sure Medicare is paying for the quality of care that beneficiaries are entitled to."

CMS hires state-level agencies to survey the homes and make sure they are complying with federal law, and can require correction plans, deny payment or end a contract with a home if major deficiencies come to light. The agency also said it would follow up on potential enforcement at the homes featured in the report.

Greg Crist, a Washington-based spokeswoman for the American Health Care Association, which represents the largest share of skilled nursing facilities nationwide, said overall, nursing home operators are well regulated and follow federal guidelines, but added that he could not fully comment on the report's conclusions without having had the chance to read it.

"Our members begin every treatment with the individual's personal health needs at the forefront. This is a hands-on process, involving doctors and even family members in an effort to enhance the health outcome of the patient," Crist said.

Virginia Fichera, who has relatives in two nursing homes in New York, said she would welcome a greater push for accountability at skilled nursing facilities.

"Once you're in a nursing home, if things don't go right, you're really a prisoner," said Fichera, a retired professor in Sterling, N.Y. "As a concerned relative, you just want to know the care is good, and if there are problems, why they are happening and when they'll be fixed."

Once residents are ready to go back home or transfer to another facility, federal law also requires that the homes write special plans to make sure patients are safely discharged.

Investigators found the homes didn't always do what was needed to ensure a smooth transition.

In nearly one-third of cases, facilities also did not provide enough information when the patient moved to another setting, the report found.

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