Tag Archives: ALJ Decisions

Circuit Court Upholds Immediate Jeopardy for Failure to Notify of Significant Change in Patient’s Condition

The U.S. 6th Circuit Court recently upheld a DHHS Departmental Appeals Board decision that found a skilled nursing facility’s (“SNF”) deficiencies were at an “immediate jeopardy” level relating to a failure to notify a physician or family member of a significant change in a patient’s condition. See, Claiborne-Hughes Health Center v. Sebelius, 6th Cir. No 09-3239, 6/25/10.

The Claiborne-Hughes Health Center is a SNF in Franklin, TN. The decision was based upon surveyors findings that the facility failed to comply with 42 C.F.R. §483.10(b)(11). Section 483.10(b)(11) requires a facility to immediately consult with a resident’s physician and notify the resident’s family members or legal representation when there is a significant change in a resident’s physical, mental, or psychosocial status.

The failure to comply with the applicable regulation related to Claiborne-Hughes’ policy on recording patient fluid-intake. Surveys completed in August and September of 2006 revealed that the facility was not sufficiently monitoring patient fluid intake in accordance with its own policies.

A copy of the decision can be found at – http://caselaw.findlaw.com/us-6th-circuit/1529702.html

DAB: CMS Revokes Pharmacy’s Medicare Supplier Number After Owner Indicted

The DHHS Departmental Appeals Board (“DAB”) upheld the revocation of a pharmacy’s supplier number even after the tainted owner sold his interest to the remaining owner who was not involved in the fraud.  In Main Street Pharmacy, LLC v.Centers for Medicare and Medicaid Services, Docket No. C -10-359, Decision No. CR2160, June 18, 2010, the DAB Administrative Law Judge upheld the revocation because of findings that the pharmacy’s enrollment information with the National Supplier Clearinghouse was not timely updated to reflect the transfer to the non-tainted owner.

DAB Decisions Can Be Found at http://www.hhs.gov/dab/decisions/index.html