Inspection·December 11, 2025

F 0571 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Limit the charges against residents' personal funds for items or services for which payment is made under Medicare or Medicaid. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility failed to assure accuracy of billing, by charging a resident's account for services covered by insurance after winning an appeal, for 1 out 3 records reviewed. (Resident #2) The findings include:A review of Resident #2's medical record revealed the resident was admitted on [DATE] to the facility under skilled nursing care after hospitalization. Resident #2's record had a Notice of Medicare Non-Coverage (NOMNC) dated [DATE], ending services on [DATE]. A review of Resident #2's medical record revealed an Expedited Appeal Documentation Request dated [DATE]. The request was reviewed and required the facility to upload the necessary documentation to the Quality Improvement Organization (QIO) (beneficiary and family centered care quality improvement organization authorized by the Medicare program to review inpatient services provided to Medicare patients) website by close of business. Resident #2's record revealed an appeal decision from the QIO dated [DATE]. The decision stated that ending services was not appropriate due to the facility's failure to provide sufficient medical records or other required documentation within the mandated timeframe. Resident #2's record revealed a completed financial responsibility statement for post skilled services dated [DATE], indicating the last covered date as [DATE]. Documentation showed that, effective [DATE], Resident #2 will transition to Private Pay/Medicaid Pending status. The noted private pay rate was $399 a day. A review of an email correspondence dated [DATE] at 3:38 PM between the Business Office Manager and the corporate Care Management Team revealed Resident #2 had active insurance coverage as supported by email documentation. However, the system deleted the email confirming this coverage. A review of an email correspondence dated [DATE] at 4:28 PM between the insurance company's Lead Clinical Review Nurse and the corporate Care Management team revealed that the resident's authorization listed [DATE] as the last covered day. Resident #2 remained in the facility under long term care status beginning [DATE]. A communication note was documented indicating that a member of the corporate Care Management team sent a secure email conveying this information. Resident #2's billing record revealed an account balance of $19,215.18 as of [DATE]. On [DATE] at approximately 9:50 AM, a phone interview was conducted with the representative for Resident #2. She stated that the facility informed her on [DATE] that, as of [DATE], the resident was not approved, therefore covered under his insurance. However, she was under the impression that her appeal was approved. She recalled receiving a phone call from the facility's Business Office Manager at 7:30 PM, informing her that she needed to come immediately to remove the resident due to an outstanding bill. She stated she was told that, because his insurance had not approved of his stay, the balance had increased to around $10,000 at a rate of $399 per day. On [DATE] at approximately 10:00 AM, an interview was conducted with the facility's Business Office Manager. She explained that she had discussed with the resident and family that Resident #2 had the option to apply for long-term care (LTC) Medicaid, which they declined. However, the resident remained on private pay Medicaid pending status, and his (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 3 Event ID: 106140 Printed: 05/28/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 106140 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pruitthealth - Southwood 2301 Bluff Oak Way Tallahassee, FL 32311 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)