Summary:
Summary Statement of Deficiencies D2005 ENROLLMENT CFR(s): 493.801(a)(4) Authorize the proficiency testing program to release to HHS all data required to-- (i) Determine the laboratory's compliance with this subpart; and (ii) Make PT results available to the public as required in section 353(f)(3)(F) of the Public Health Service Act. This STANDARD is not met as evidenced by: Through review of the Casper 155D report, proficiency testing documentation and interview it was determined that the laboratory failed to report proficiency testing results to CMS on two of two 2018 proficiency testing events reviewed. Findings follow: A. Review of Casper 155D reports for Mercy Clinic Urgent Care - Towson, CLIA # 2139224, revealed that the laboratory did not appear on the report. B. Review of the API Hematology/Coagulation proficiency testing reports for 2018 event number one and 2018 event number two revealed that the laboratory was registered with the proficiency testing agency as " Mercy Clinic Urgent Care Towson, 4600 Towson Avenue, Suite 101-N, Fort Smith, Arkansas, CLIA # 04D0709072". CLIA # 04D0709072 was the number assigned to a laboratory at the same location that was terminated in November 2017. C. In an interview on August 1, 2018at approximately 04:00 PM the technical consultant identified as number 2 on the CMS 209 report confirmed that when the proficiency testing service was ordered for 2018 the CLIA number was not changed to the new CLIA number for the laboratory. Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 1 --