Whena nursing home is not in compliance with Medicare or Medicaid requirements, they could potentially lose their ability to participate with the government agency. That means they would lose the funding the government provides which could ultimately lead to a nursing home closing its doors for good. The reason being is that a majority of nursing home residents are only able to live in a facility that accepts Medicaid as this is their primary source of payment for the services they have rendered. Now, a nursing home doesn’t just lose their ability to participate with the government program when they fail to abide by one or more federal requirements, rather,  Medicare will decide to shut the facility out if it fails to remedy the issues found.


How does the CMS and the State Medicaid Agency determine what action is taken when a violation Is found?


The Centers for Medicare & Medicaid Services (CMS) will first determine which federal requirements the facility was not in compliance with and will then impose one or more remedies, which simply means “enforcement actions taken against a nursing home.” Now, in order for the agency to “select the appropriate enforcement remedy (ies), the scope and severity levels of the deficiencies [or violations] must be assessed.” The agency uses four levels to determine the degree of severity for the violation, or deficiency, they have found. These levels include:


  1. No actual harm with potential for minimal harm.
  2. No actual harm with a potential for more than minimal harm that is not immediate jeopardy.
  3. Actual harm that is not immediate jeopardy.
  4. Immediate jeopardy to resident health or safety. If a facility’s deficiency is cited with this annotation, it means there were one or more situations where the “facility’s noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.”


The agency will also assess the scope level of deficiency which “reflects how many residents were affected by the deficiency.” There are three scope levels which include:


  • Isolated
  • Pattern
  • widespread


After the agency determines the degree of severity of the violation (deficiency) as well as the scope level, they then cite the facility which is given six months to make the necessary modifications so that it is in compliance with federal regulations. If they fail to do so, the facility is then terminated from participation in Medicare and/or Medicaid. In the event the nursing home fails to return to substantial compliance within three months, they risk having Medicare/Medicaid deny payments for residents admitted into the nursing home who qualifies for this aid.


Have any nursing homes in Raleigh, NC lost Medicare/Medicaid funding recently?


According to Becker’s Hospital Review, two nursing homes in NC received letters from the Centers for Medicare and Medicaid Services after deficiencies were found. The letters stated that if the facilities continued to remain out of compliance with federal regulations, they would be terminated from the Medicare program. One of the facilities at risk was Universal Healthcare North Raleigh after inspectors found out that a resident who had suffered a stroke, fell from his bed and was ignored for more than hour by staff members who later found him and scolded him [Source:Fox News].

The other facility that was at risk of losing Medicare funding was Universal Healthcare Lillington after video footage revealed staff at the facility providing improper care to a female resident. The agency has already threatened the facilities that they wouldn’t be able to accept new Medicare patients until they were in compliance with federal regulations and both were at risk of being terminated from the program given they didn’t make the necessary changes to comply with federal requirements.


Is your loved one living in a nursing home in Raleigh, NC that isn’t providing the proper care and treatment?


If your loved one has been subjected to receiving substandard care and has suffered as a result, you are encouraged to contact a nursing home abuse lawyer in Raleigh, NC. Our attorneys can help you take the necessary forms of action so that the facility is recognized for its misconduct and held accountable for the pain and suffering they have caused your loved one to suffer from.