CMS suspends PACE program that cherry-picked patients

A Programs of All Inclusive Care for the Elderly organization is being accused of denying enrollment to patients who needed expensive medical services, according to the Centers for Medicare & Medicaid Services.

CMS suspended enrollment for new participants to the St. Louis-based Alexian Brothers Community Services PACE program in a Nov. 17 letter. It said the organization had failed to provide medically necessary items and services to patients, and discouraged or denied enrollment for patients with costly medical conditions.

CMS also cited Alexian Brothers for failing to keep accurate medical records, failing to maintain an adequate grievance process and failing to properly process newly enrolled beneficiaries. The suspension will remain in effect until CMS and the Missouri Department of Social Services are satisfied that Alexian Brothers' deficiencies “have been corrected and are not likely to recur,” the letter stated.

Alexian Brothers is owned by Ascension Health, the largest nonprofit health system in the U.S. In addition to hospitals and other sites of care, Ascension operates more than 30 senior care facilities across the country.