Livingston Care Ctr. v. United States Dept. of Health & Human Svcs.

Medicare Regulations

Livingston Care Ctr. v. United States Dept. of Health & Human Svcs., No.
03-3489 (6th Cir. Aug. 24, 2004)

The Sixth Circuit Court of Appeals affirmed a grant of summary judgment in
favor of the Department of Health and Human Services, holding that there was
sufficient evidence to establish that a skilled nursing home facility did not
prevent the development of pressure sores on three residents and that the facility
failed to provide the requisite pressure-relieving devices in five residents’
plans of care. The appeals court found that the facility failed to comply with
Medicare regulations requiring skilled nursing facilities to provide a prescribed
level of medical skin care and services for their residents.

CMS filed for summary judgment on the skilled nursing
home facility’s
failure to comply with the regulations, contending that several nursing home
residents suffered from pressure sores, which the nursing home found were medically
unavoidable. The court found that even though the rules governing long-term
care facilities in the regulations do not provide for summary judgment proceedings,
the HHS has promulgated guidelines that are used by its administrative tribunals.
It held that the facility did not prevent the development of pressure sores
on its residents and failed to provide the required pressure-relieving devices
in each resident’s plan of care. The court similarly found that the facility
did not present sufficient evidence on which to challenge CMS’s conclusion
that it failed to provide the necessary care and treatment to prevent the pressure
sores. Accordingly, it affirmed the grant of summary judgment in favor of the
HHS.