The Centers for Medicare and Medicaid Services (CMS) recently stated that it will begin publicly posting all civil money penalties imposed against skilled nursing facilities. In the past, the government would not publicly disclose these fines. Moving forward, the feds will disclose the fines — whether paid by the facility or not.
Taking a step back: What are the basics of these penalties?
The federal government conducts regular surveys of skilled nursing facilities to help ensure compliance to all applicable regulations. There are different levels of surveys. A standard survey refers to the periodic, resident-centered inspection. The inspectors gather information about the quality of service and use this to help determine compliance. If the surveyor suspects substandard quality of care, they can expand or extend the survey. An expanded survey would extend the review beyond the core tasks highlighted in the standard survey while an extended survey evaluates additional participation requirements.
The CMS points out that these surveys are most effective when continued, instead of cyclical, in nature. As such, there is a high likelihood that your organization will find itself subject to multiple such surveys and, based on the report noted above, any resulting fines will receive public scrutiny.
Dealing with the results: Can we appeal the fines?
Facilities generally have the right to appeal the surveyor’s findings, including any resulting fines. A skilled nursing facility that wishes to appeal a CMS imposed civil money penalty should send its request for a hearing to the Departmental Appeals Board. A facility can choose to appeal or waive the right to appeal all or only a portion of the civil money penalties.