Later, the DAB, the facility asserted it did not construe the July 31 determination as an appealable determination separate and distinct from the August 21 determination. The facility, in its request for a hearing, dated October 20, 2014, appealed CMS’s August 21 determination and requested an extension to appeal the July 31 determination, because it had “overlooked the timeframes given the number of letters and communications that were occurring at the time” and actions “to assure the safety of residents and implement swift and effective corrective action.” The ALJ held this was not a satisfactory showing of good cause. On August 21, 2014, CMS notified the facility that an August 7, 2014, revisit survey had resulted in the removal of one deficiency, but the facility remained out of compliance with other requirements, which warranted additional remedies, with 60 days to appeal this determination. On July 31, 2014, the Centers for Medicare and Medicaid Services (CMS) notified the facility that it was not in substantial compliance with various participation requirements, including deficiencies at the immediate jeopardy level, and that it had 60 days to appeal. George Health Care Center, DAB 2645 (June 30, 2015), the Departmental Appeals Board (DAB) affirmed the conclusion of the administrative law judge (ALJ) that an appeal was untimely and good cause to excuse the late filing did not exist. Lack of Good Cause to Excuse Late Filing. Administrative Survey and Certification Casesĭepartmental Appeals Board (DAB) Decisions While sympathetic to the SNF’s circumstance, the current backlog in the administrative appeal process was “not so egregious as to warrant circumvention of the administrative appeals process,” and the court was not in a position to provide a fix for the backlog, despite the financial hardship for the SNF. The court dismissed the lawsuit for failure to exhaust its administrative remedies. On October 30, 2014, the SNF filed a civil action, on due process grounds, seeking an injunction against HHS from continuing the payment suspension and prepayment review. HHS did not make an initial determination or give notice of an overpayment as a result, as late as October 27, 2014, however, the SNF was unable to initiate the administrative appeal process. Department of Health and Human Services (HHS) suspended Medicaid payments to a skilled nursing facility (SNF), effective July 25, 2014, based "on reliable information that an overpayment exists or that payments to be made may not be correct." According to the SNF, the “reliable information” was the finding of HHS’s zone program integrity contractor (ZPIC) that the SNF had billed therapy services at a level beyond what was medically necessary for the treatment of Medicare beneficiaries. Federal Court Casesįederal Court Lacks Jurisdiction to Address Administrative Delay. The following summary highlights key federal court developments and administrative decisions involving skilled nursing facility survey and related issues during the second quarter of 2015.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |