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Evaluation

Medical Direction

(SA04) Anatomy of an Appeal of a CMS Enforcement Action

Saturday, March 9, 2024
10:30 AM – 11:30 AM CT
Room: 221
CMD Management Credit Recording
CME: (1.0) MOC: (1.0) CMD Management: (1.0) NP Pharmacology Hours ()
Disclosure(s):
Alan C. Horowitz, Esq., RN: No financial relationships to disclose.
Karl E. Steinberg, MD, CMD, HMDC, HEC-C: No financial relationships to disclose.
When a SNF appeals a CMS enforcement action, typically the DON, administrator, medical director and/or attending physician as well as PAs and NPs may be called to testify as a witness for the facility. This presentation will focus on, among other aspects of an appeal, witness preparation (e.g., preparing for a cross-examination and questions by the ALJ). The basis of the information presented and reviewed will be the hundreds of CMS appeals the presenter has been directly involved with over more than 20 years. Virtually any healthcare worker who has relevant knowledge of the facts related to an alleged deficiency - from a nurse aide to the medical director - may be a witness for the SNF and subject to cross-examination by CMS' counsel. Effective strategies for being a compelling witness will be explored.

Learning Objectives:

At the completion of this session, learners will be able to:
  • Understand what is involved with an appeal of a CMS enforcement action and how counsel will help them prepare for their testimony and cross-examination.
  • Appreciate the key role that medical directors, attending physicians, and NP/PAs have at each stage of disputing unsupportable allegations of deficiencies and understand the relative pros and cons of IDR as well as informal IDR (IIDR) Attendees will learn the relative advantages and disadvantages of both IDR and Informal IDR (IIDR)
  • Explore the various stages of an appeal and understand what to expect from the presiding Administrative Law Judge (ALJ) as well as opposing counsel from CMS.
  • By exploring actual cases and examples of testimony, cross-examination and actual questioning by an ALJ, attendees will be better prepared for trial/hearing in those situations where a SNF formally challenges erroneously cited deficiencies.