LIBERTY, NY — On November 13, the Sullivan County Legislature held a brief special meeting to authorize the payment of a $9,620 fine from the Centers for Medicare and Medicaid Services (CMS), imposed on the Care Center at Sunset Lake.

The resolution, introduced by chairperson Nadia Rajsz and passed with seven votes, authorized the expenditure of county funds to cover a fine. District 5 Legislator Cat Scott made the motion, seconded by District 6 Legislator Luis Alvarez.

The county-owned adult care center has faced scrutiny and fines in past dealings with Infinite Care, the center’s management company. Legislators noted that, due to prior negligence from Infinite Care, the county had already paid $46,000 in fines. Payment on the new fine was due by November 20. 

The fine in question was not a previous March fine but a September 2024 fine.

Scott asked, “This is from September 2024? How do they arrive at this number? How was the fine reduced? So we are still waiting on the fine announcement for March?”

County manager Josh Potosek said that the original fine was $14,800 and the latest figure dropped to $9,620. Scott asked if the board could get the letter explaining the negotiation about the fine reduction.  

Legislators went back and forth discussing the nature of the amount of the fine.

“Is there a fee schedule for every infraction?” asked Rajsz. 

“They assess it and then come up with a number,”said Potosek.

Rajsz asked, “Do they just get up in the morning and a number comes out?” 

Scott said, “It’s a fine. It’s a punishment.”

County attorney Robert Freehill said, “I believe if you look in their regs, there is a maximum fine that can be posted. It’s like an adhesion contract. You can negotiate a little bit as the county manager has done. You’re at their mercy, nonetheless.”

“The county manager negotiates between the department of health and the county?” asked Scott.

“We have conversations with the facility, but I don’t have direct conversations with CMS,” replied Potosek.

“Who has direct negotiations with CMS?” asked Scott.

“The administrator of the adult care center,” deputy county manager Michelle Bowers responded. 

Rajsz concluded the discussion, saying, “We need to have further discussion on this.”

Alvarez compared the fine in question to what Child Protective Services has to deal with. For example, they could negotiate a $10,000 fine to $5,000—it’s common practice, he said.

Bowers clarified that the incident for the fine discussed happened on February 14, 2024. The enforcement cycle was September 2024 and the revisit was December 2024, she said.

The sections cited in the resolution, Sections 1819(h) and 1919(h), are the  enforcement chapters of the nursing-home law. The chapters do not explicitly state the violation itself; they only give the government the authority to impose a penalty. In other words, it only explains how the government is allowed to fine them.

Those details can be found in the deficiency report, which is available to the public through a database released by investigative news website ProPublica.  The statement of deficiencies documents the violations leading to civil money penalties under Sections 1819(h) (Medicare skilled nursing) and 1919(h) (Medicaid nursing). 

The county was fined after inspectors found problems at the facility totaling nine deficiencies, including staff not following care plans and missing checks on residents. The fine is authorized under federal law, which allows CMS to levy penalties for such deficiencies.

For more, see:

https://projects.propublica.org/nursing-homes/homes/h-335628?utm_source

https://www.medicare.gov/care-compare/inspections/pdf/nursing-home/335628/health/health-inspection?date=2024-09-27