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InnovAge California PACE Suspended, CMS CITEs Care Deficiencies

Analysis  |  By John Commins  
   September 27, 2021

A CMS audit found that Sacramento-based InnovAge was out of compliance in several areas.

The federal government has suspended the InnovAge California PACE program from enrolling new members after a May audit determined that the Sacramento-based Medicare provider repeatedly failed to provide its enrollees with medically necessary equipment and services.

"CMS has determined that the seriousness of these deficiencies requires the suspension of any new enrollments of Medicare beneficiaries into InnovAge Sacramento," John A. Scott, director, Medicaid Parts C and D Oversight and Enforcement Group, said in a September 17 letter to Innovage California PACE COO Maureen Hewitt.

"The enrollment sanction will remain in effect until CMS is satisfied that InnovAge Sacramento has corrected the causes of the violations and the violations are not likely to recur," Scott said. "This enrollment suspension will apply to the enrollment of all Medicare beneficiaries regardless of their Medicaid eligibility status."

The CMS audit found that InnovAge was out of compliance in several areas, including: a failure to ensure participants received necessary services from certain specialists; a failure to coordinate care, review specialists' diagnoses, and provide services recommended by specialists; unwarranted delays in care delivery; and a failure to provide specialists services, including ophthalmology, optometry, dermatology, and nephrology.

The audit noted that even though InnovAge Sacramento was not contracted for these services, the provider "is still responsible for furnishing all services covered under the PACE benefit, which includes all Medicare-covered items and services, all Medicaid-covered items and services, and all other services determined necessary by the IDT to improve and maintain the participant’s overall health status."

InnovAge issued a statement acknowledging the audit and said it was "focused on working closely with CMS to expeditiously address and resolve the points they've identified."

"As a healthcare provider in a highly regulated industry, InnovAge has established protocols to cooperate with and fully support regulatory measures," the company said. "Our primary concern is always the health and safety of our participants in every market we serve."

“CMS has determined that the seriousness of these deficiencies requires the suspension of any new enrollments of Medicare beneficiaries into InnovAge Sacramento.”

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.


KEY TAKEAWAYS

The audit noted that InnovAge Sacramento "is responsible for furnishing all services covered under the PACE benefit, which includes all Medicaid/Medicaid-covered items and services, and all other services determined necessary."

InnovAge issued a statement acknowledging the audit and said it was "focused on working closely with CMS to expeditiously address and resolve the points they've identified."


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