”Based on determinations by our independent medical review, the medical records did not support the necessity for inpatient hospital services and should have been billed as outpatient or outpatient with observation,” the report reads. He also noted that Sunrise’s inpatient program is the only one certified by the Commission on Accreditation of Rehabilitation Facilities (CARF) in Southern Nevada.Īmong the conclusions Sunrise is disputing is the audit’s contention that inpatient admissions did not meet Medicare criteria. Sklamberg said Sunrise received a preliminary version of the report and noted that it acknowledges multiple instances where the hospital disputes the audit’s findings. The report, which was released last month, also asks Sunrise to strengthen its policies to comply with Medicare requirements.

Those claims have been accepted by the OIG and removed from the amount it wants Sunrise to repay.Īccording to the report, Sunrise billed Medicare for unnecessary inpatient visits, or situations where the patient did not meet the standard for necessary inpatient care - a situation where “the ordering physician expects the patient to require care for a period of time that crosses two midnights.” According to the report, the hospital did not comply with Medicare billing procedures in 54 of the claims, although five were reprocessed during the course of the audit. “We strongly disagree with the OIG’s findings related to our inpatient rehab facility because we believe that the care we provided to our patients was necessary and effective,” he said.Īs part of a routine audit, the OIG’s office looked at 100 inpatient and outpatient claims. Department of Health and Human Services, triggering a process that could take “several years,” CEO Todd Sklamberg said Thursday. Sunrise Hospital will appeal the decision by the Office of the Inspector General for the U.S. LaCoria still sees and talks to her Sunrise case managers.Sunrise Hospital and Medical Center in Las Vegas (Las Vegas Review-Journal)Ī federal audit has concluded that Sunrise Hospital and Medical Center of Las Vegas improperly billed Medicare for more than $23.6 million in services and called on it to refund the money. She is now nine years old and has caught up on her grade level and is actually reading one grade above her peers. The Rawlings were happy to adopt LaCoria into their family. As Cora began to build trust, an attachment formed. Sunrise offered immense support to the Rawlings during this time.

LaCoria was also two school grades behind her peers. It was not uncommon for LaCoria to hoard food or to sneak food leftovers from the garbage and hide it under her bed. Lacoria was not used to a routine or having a meal three times a day. Sunrise worked with LaCoria and her new foster family. LaCoria was seven years old at the time of her placement and had experienced a lot of trauma for a girl her age. The Rawlings, a Sunrise foster family, were able to bring LaCoria into their home. However, she became a ward of the state when her grandma turned ill and was no longer able to care for her. She ended up living with her grandma (NiNi). LaCoria’s mother struggled from a drug addiction and her father was serving a 15-year sentence in prison.

She continues to receive outpatient services. Taya worked hard for almost two years with staff. Taya started working through her experiences and started to understand that what had happened to her did not have to define who she was. This worked! Taya began to open up and started sharing things with staff that she had never told anyone else. Often they would bring in books, read the books on there own time, just to connect with Taya and discuss the story line. Sunrise staff used her love for reading to connect with Taya.

She was extremely introverted at times and would escape into books to avoid her pain. There were times that Sunrise staff felt as if they had no answers, but they continued to love Taya throughout her outbursts. Taya would test boundaries, act out physically, cut herself, and attempt to harm others. However, Sunrise staff refused to give up. Sunrise staff knew that building a relationship with Taya was not going to be an easy task. She had experienced physical abuse not only by her relatives, but also within one of her foster homes. Taya would run away whenever a bond seemed to be forming with a foster family. She had been in 12 foster homes before coming to Sunrise. Taya bounced around from foster home to foster home.

Sunrise hospital