CMS puts surveyors on alert for those 'gaming' system

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Expanded surveys will focus on staffing, MDS coding
Expanded surveys will focus on staffing, MDS coding

Federal regulators say surveyors need to prevent providers from possibly “gaming” the system when it comes to the timing of surveys and sales. 

The Centers for Medicare & Medicaid Services instructed surveyors in a Sept. 6 memo to be on the watch for situations in which there is a quick hand-off of ownership and designation for Medicare participation.

If surveyors disregard standing policy and conduct initial surveys of recently bought facilities instead of following up on complaint investigations and other “core work” first, they could allow facility sellers to take advantage of the survey and certification system. Providers who owe CMS for overpayments or civil monetary penalties could more easily sell a property to escape liability if would-be buyers are quickly accepted into the Medicare program, regulators warned in the memo.

When a new owner acquires an existing facility that has been certified for Medicare participation, CMS can automatically assign Medicare certification to the new owner. However, the new owner may also reject automatic assignment. In this case, the new owner generally would not be liable for reimbursing Medicare for overpayments that occurred prior to the sale. A full initial survey would be needed to re-establish Medicare certification.

Much of the concern centers on surveyors disregarding CMS policy in order to, ostensibly, speed the transition process from one owner to the next. The CMS memo said  any survey that takes place less than two weeks after a facility has changed ownership with rejection of automatic assignment “warrants closer review.”

The memo also said that surveys must be unannounced, with no discussions between the owner and surveyor.


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