Tuesday, November 12, 2013

Fairfax Nursing Home, Inc. v. U.S. Dep’t of Health and Human Services case brief

Fairfax Nursing Home, Inc. v. U.S. Dep’t of Health and Human Services case brief summary
300 F.3d 835 (2003)

Petitioner nursing home was assessed a civil monetary penalty because of its failure to comply substantially with Medicare regulations governing the care of respirator-dependent nursing home residents. An administrative law judge (ALJ) affirmed the penalty and the Department of Health and Human Services Department Appeals Board, Appellate Division affirmed the ALJ's decision. The nursing home sought judicial review of that decision.


The nursing home participated as a skilled nursing facility (SNF) in Medicare and Medicaid as a provider. The primary method of regulation of SNFs was by unannounced surveys by state agencies with whom the Department of Health and Human Services (HHS) contracted. If the state survey found violations of Medicare regulations, the state could recommend penalties to the Center for Medicare and Medicaid Services (CMS). CMS imposed a penalty on the nursing home because of a series of failures in care of ventilator-dependent residents. When the nursing home's administrative appeals of the penalty were denied, it sought judicial review.


  • The court found that the ALJ clearly was aware of the proper standard for immediate jeopardy and applied it correctly. 
  • The other findings of the ALJ made clear that the lapses in monitoring of the patients were of a severe nature. 
  • The ALJ's opinion also made clear that he focused not simply on the situation of each individual patient, but also on the entire state of readiness in the facility during the time in question. 
  • The record firmly supported HHS' determination that a state of immediate jeopardy to resident health existed at the nursing home.

The board's decision was supported by substantial evidence and, therefore, it was affirmed.

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