If there were ever a doubt that CMS (with a push from health reform legislation) was serious about its focus on enrollment issues, the list of recent cases below removes any doubts.

Compliance with the new enrollment standards has become more complicated over the last few years and complicated even further with the changes beginning in March 2011.  Even providers and suppliers who have been diligent in their compliance efforts are being hit with enrollment-related audits and being put under the microscope.

The Nelson Mullins National Healthcare Practice Team has been assisting all types of providers and suppliers in navigating their way through these audits and reviewing and improving their existing enrollment platform to avoid future issues --- and costs. 

In this enforcement environment, there is no substitute for an ounce of prevention. 

Recent Enrollment Cases 2011

•  Caretenders Visiting Services of Columbus, LLC, vs. CMS, CR2311, January 19, 2011—Because it ceased providing services, Petitioner no longer met statutory definition of a home health agency; CMS properly terminated its Medicare participation, (Apr. 6, 2011)
  
  
• West Miami CMHC, Inc. vs CMS, CR2315, January 23, 2011—Sustained CMS's determination to revoke Petitioner's billing privileges on basis that it was not operational as a Community Mental Health Centers because it was not actually providing all required core services to patients, (Apr. 6, 2011)
  
  
• First Care Medical Equipment, LLC,vs CMS, CR2316, February 3, 2011—Petitioner was not operational when it was not open and accessible on two separate occasions during its posted hours of operation; CMS's motion for summary judgment granted and revocation of Petitioner's supplier billing number sustained, (Apr. 6, 2011)
  
  
• CompRehab Wellness Group, Inc. v. CMS, CR2317, February 4, 2011—CMS's determination to revoke Petitioner's Medicare billing privileges sustained on basis that it was nonoperational; Petitioner failed to show that it met all Medicare requirements for comprehensive outpatient rehabilitation facility, (Apr. 6, 2011)
  
  
•  Vikki L. Green, LMSW v. CMS, CR2318, February 7, 2011—CMS had a legitimate legal basis to deny Petitioner's enrollment application; CMS's motion for summary judgment granted, (Apr. 6, 2011)
   
• Homemakers A+ Services v. CMS, CR2322, February 14, 2011—CMS granted summary judgment, Petitioner's billing privileges revoked, did not notify CMS it moved to another location, CMS was not able to conduct on-site visit of Petitioner's facility, (Apr. 6, 2011)
  
  
•  RehabCare Group East, Incorporated d/b/a RehabCare v. CMS, CR2323, February 15, 2011—CMS was authorized to terminate Petitioner's Provider participation, was out of compliance with six Medicare Conditions of Participation, (Apr. 6, 2011)
  
  
• Robin H. Vaughan v. CMS, CR2325, February 18, 2011—CMS motion for summary judgment granted, Petitioner did not qualify as non-physician practitioner supplier, (Apr. 6, 2011)
  
  
• Plott Nursing Home v. CMS, CR2326, February 17, 2011—Petitioner was not in substantial compliance with program requirements, civil money penalties and denial of payments for new admissions imposed, (Apr. 6, 2011)
  
  
• Emerald Medical Services, LLC vs CMS, CR2328, February 25, 2011—CMS appropriately revoked Petitioner's supplier number for failure to comply with Medicare DMEPOS supplier requirements;summary judgment in favor of CMS granted, (Apr. 6, 2011)
  
  
• Robert Knapp, M.D. v. CMS, CR2329, March 1, 2011—CMS had authority to revoke Petitioner's enrollment and billing privileges for noncompliance with Medicare enrollment requirements; CMS granted summary judgment, (Apr. 6, 2011)
  
  
• Courtney Home Care Services vs. CMS, CR2330, 3/2/2011—CMS was authorized to terminate Petitioner’s participation in Medicare program as a home health agency, which was out of compliance with five conditions of participation, (Apr. 6, 2011)
  
  
• Cich Chiropractic, P.A., LLC, and Curtis L. Cich, M.D. vs CMS, CR2336, March 9, 2011—CMS's motion to dismiss Petitioners' hearing request granted, but will not affect any future request for hearing Petitioner may have regarding this revocation, (Apr. 6, 2011)
  
  
• Amann's Orthopedics and Prosthetics, Inc. vs. CMS, CR2337, March 15, 2011—Summary judgment to CMS granted because it acted within its regulatory authority to revoke Petitioner's billing privileges for noncompliance with Medicare requirements, (Apr. 6, 2011)
  
  
• Briarwood Community Mental Health Center vs CMS, CR2338, March 11, 2011—Community Mental Health Center's (CMHC) application to participate in the Medicare program was denied because it did not demonstrate it was CMHC within meaning of Law, and did not show it provided core services of CMHC required by Law, (Apr. 6, 2011)
  
  
•  Texas Rejuvenation Medical Supply vs CMS, CR2340, March 12, 2011—CMS's determination to revoke Petitioner's Medicare billing privileges reversed, Petitioner moved without a break in its operations and timely notified CMS its change of address within required 30 days, (Apr. 6, 2011)
  
  
•  St. Clair's Home Health, Inc. vs CMS, CR2341, March 18, 2011—Home health agency failed to maintain substantial compliance with all Medicare conditions of participation; CMS was authorized to terminate its program participation, (Apr. 6, 2011)
  
  
•  Darryl Camp, M.D., and Darryl Camp, M.D., PA vs CMS, CR2342, March 21, 2011—Petitioner was entitled to effective date of enrollment in Medicare program of February 10, 2010, and entitled to retrospectively bill for services rendered as of January 11, 2010, (Apr. 6, 2011) 

For information on current issues in the healthcare industry, please visit the Nelson Mullins Healthcare Reform Library at www.nelsonmullins.com/pages.cfm/Healthcare_Library. For information on Nelson Mullins, go to www.nelsonmullins.com. For more information on our National Healthcare practice, contact one of the following attorneys: 

Jana Kolarik Anderson
202.545.2960
Jana.Kolarik@nelsonmullins.com

Ross Sallade
919.329.3875
ross.sallade@nelsonmullins.com