The CMS has halted all enrollment of a program that cares for poor seniors at Alexian Brothers Community Services in St. Louis. The agency found numerous violations where the organization failed to provide necessary services and avoided enrolling sick, more expensive patients.
Last week, the CMS sent a letter (PDF) to Chris Deck, CEO of Alexian Brothers Community Services, announcing the suspension of PACE membership. Ascension Health, the largest not-for-profit health system in the country and a prominent provider of post-acute services, owns Alexian Brothers.
The Program of All-Inclusive Care for the Elderly, or PACE, is for people ages 55 and older who are low-income and need some of the most intensive care. Private organizations contract with the CMS and state Medicaid agencies to provide services for PACE members, such as home care, meals and prescription drugs, and those organizations receive capitated payments in return.
Alexian Brothers had 169 PACE members as of this month, according to CMS data. Nationwide, there are about 33,400 PACE beneficiaries.
The CMS outlined eight violations where Alexian Brothers “failed substantially to provide participants medically necessary items and services that are covered PACE services, and that failure adversely affected (or had a substantial likelihood of adversely affecting) participants,” the letter reads.
For example, aside from outright denying needed healthcare services, Alexian Brothers failed to keep medical records up-to-date for its PACE members, which the CMS said led to delays or denials of care. The CMS also alleged the organization cherry-picked its patient population by not assessing how much care seniors needed and by not notifying members of their appeal rights.
Alexian Brothers has submitted a corrective action plan, but regulators still have to vet the plan and make sure conditions are actually improving. Ascension officials did not immediately respond to a request for comment.
The punishment builds on the federal government's heightened scrutiny of Medicare and Medicaid programs. The CMS has increasingly fined and sanctioned Medicare Advantage plans that fall short of federal guidelines.