A home health care and hospice agency in Boise has settled its lawsuit against Medicare after the federal government warned that it would not pay for Medicare patients because of two failed inspections.
Saint Alphonsus Home Health and Hospice sued in March, accusing the Idaho Department of Health and Welfare of allowing an aggrieved former employee of the agency to conduct the program’s inspection on behalf of the federal Centers for Medicare and Medicaid Services.
Health and Welfare’s Bureau of Facility Standards found “systemic failures” at the agency in October. A follow-up inspection in December also found problems. The violations included an unlicensed nurse and incidents in which employees did not administer medication and treatments as prescribed by doctors.
Medicare then notified Saint Alphonsus that it would no longer be allowed to take Medicare patients.
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Saint Alphonsus Home Health went to court to block Medicare’s sanctions until it had a chance to appeal the findings. The company called the inspection “fatally flawed” and said it was overseen by a “hopelessly conflicted and biased nurse.”
The company had dismissed the nurse in 2014 after concerns arose about his work, the lawsuit said. In response, the U.S. Department of Health and Human Services called the conflict-of-interest argument a “red herring.” The nurse remains a co-supervisor of the non-long-term care inspections team, according to the Idaho Department of Health and Welfare.
A judge agreed to put the Medicare sanctions on pause while the company appealed.
“[The] parties were able to work together to devise a plan to halt the termination proceedings while ensuring the quality of health care services and promoting positive patient outcomes,” an emailed statement from Saint Alphonsus Health System said. That means the agency will be allowed to keep taking Medicare patients.
Saint Alphonsus said the violations did not affect patient health and safety. It declined to provide any other information about the settlement.
Saint Alphonsus Home Health and Hospice is a joint venture between Saint Alphonsus Health System and Frontier Home Health and Hospice, a network of agencies in the Mountain West.