Harmony Healthcare Blog

Immediate Jeopardy: Revised Parameters and Referring Crimes to Law Enforcement

Posted by Kris Mastrangelo on Thu, Sep 19, 2019

Edited by Kris Mastrangelo

linkedin post Kris blog 9.19


Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency

This past year, The Centers for Medicare and Medicaid Services (CMS) made multiple adjustments to the guidelines on Immediate Jeopardy.   

For those new to the industry, Appendix Q is the section of the State Operations Manual (SOM) that defines Immediate Jeopardy and Surveyors use this guidance when making citations during health inspection surveys. 

In March of 2019, surveyors received revisions on the parameters for citing Immediate Jeopardy. 

The three elements of Immediate Jeopardy are:

  1. Non-compliance with one or more federal, health, safety or quality regulations.
  2. Serious harm, injury, impairment, death, happened or is likely to happen because of an identified non-compliance issue.
  3. The need for immediate action to prevent serious harm from happening or recurring.

Download  Consolidated Billing: 5 Major Categories Skilled Nursing Facility

Referring Crimes to Law Enforcement

On 7.31.19, The Centers for Medicare and Medicaid Services (CMS) posted a memorandum to Appendix Q elaborating when a Skilled Nursing Facility (SNF) must report suspected illegal acts to law enforcement.

The additional rules defined in Appendix Q specifies that:

“when a deficiency is identified, if illegal activity is connected to the deficiency, the state surveyor and state survey agency have an obligation to report the illegal activity to law enforcement. 

“When the identified noncompliance is determined to have been caused by, or has led to a criminal act, reporting must be made to local law enforcement. If the entity refuses to report, or the surveyor cannot verify that a report was made to local law enforcement, the surveyor must consult with his/her supervisor immediately, and the State Agency must report the potential criminal incident to law enforcement immediately.”

Harmony Healthcare International (HHI) is available to assist with any questions or concerns that you may have.  You can contact us by clicking here.  Looking to train your staff?  Join us in person at one of our our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 

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