"The CMS has concluded that VCH failed substantially to provide its participants with medically necessary items and services that are covered PACE services," the agency said in a letter sent to Via Christi last week. "This determination was made as a result of severe clinical and operational deficiencies."
Ascension Health owns VCH.
The agency's cited VCH for failing to schedule specialist visits in a timely fashion, including one instance where the plan didn't attempt to set up a dental appointment for an enrollee with broken teeth. That patient was hospitalized later due to a tooth abscess.
In another case, an enrollee with an intellectual disability sustained a foot injury in January 2017. Despite repeatedly complaining to VCH about the pain, the patient didn't receive proper treatment and had to have the foot amputated.
All in all, the CMS cited at least a dozen instances of substandard care coordination in its letter.
"The nature of VCH's substantial noncompliance supports the immediate suspension of VCH's ability to enroll new participants into its PACE program," the letter said.
The agency gave Via Christi until Oct. 11 to provide a corrective action plan for the various deficiencies outlined.
An Ascension spokesman said the plan is addressing the findings identified by the CMS.