Appeals court upholds $4,000-a-day fines for SNF, rejects vital signs documentation arguments

Share this content:

The Centers for Medicare & Medicaid Services was justified in fining a Kentucky skilled nursing facility $4,050 a day for three months following a resident's death, a U.S. Appeals Court recently ruled.

The case involves an 87-year-old resident of Life Care Center of Bardstown, who experienced two episodes of vomiting prior to being transported to a hospital and dying, on the morning on Jan. 2, 2007. CMS conducted a survey after the resident's death, and found the facility noncompliant with several Medicare and Medicaid participation requirements. It levied monetary penalties for the period of noncompliance, starting on the day of the resident's death through March 27.

Life Care Center appealed the citations and the duration of penalties. One of its arguments was that it had a facility policy in place to only record residents' vital signs if they were abnormal. The appeals court ruled that there was no evidence such a policy had been in place, and upheld the CMS citation for noncompliance with the quality of care requirement. 

The judges also upheld the citation related to the facility administration requirement, noting that the SNF's other violations placed the resident in immediate jeopardy, indicating administrative mismanagement.

CMS appropriately fined the facility on a daily basis until it could determine that proper training and other changes had resolved the immediate jeopardy issues, the appeals court judges stated in their Sept. 6 ruling.