Tag Archives: Medicare Enrollment

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

CMS to Share Terminated Provider and Supplier Information with States

In order to implement requirements in the the Patient Protection and Affordable Care Act of 2010 (“PPACA” or the “Health Reform Bill”), CMS is starting to share information with the states about providers who are terminated from participation in Medicare.  CMS is going to start sharing the information via e-mail while it works on developing an electronic database.

Section 6401(b)(2) of the PPACA requires CMS to establish a process to make available to State Medicaid and CHIP agencies certain information on Medicare providers and suppliers that are terminated from participation in the Medicare program or CHIP. Additionally, Section 6501 of the PPACA requires state Medicaid programs to terminate any Medicaid provider that has been terminated from Medicare.

See this recent CMS Program Integrity memorandum from the CMS Center for Program Integrity.

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