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Session 8 | The CMS Schizophrenia Audit: What Facilities Need to Know
Time: 8:00 to 9:30 a.m.
Type/Topic: Quality/Person-Centered Care Practices
Session Summary
The Centers for Medicare & Medicaid Services' (CMS) scrutiny of schizophrenia diagnoses has intensified, placing nursing facilities at increased risk for audits, citations, and penalties as regulatory expectations continue to evolve. Understanding how these audits are triggered and how to prepare for one is critical to maintaining compliance and protecting patient care. This session provides a practical overview of the CMS Schizophrenia Audit, including diagnostic requirements, common audit triggers, key F-tags, and current CMS expectations for clinical documentation. Attendees will learn how audits are initiated, what surveyors are reviewing, potential enforcement outcomes, and actionable strategies to remain audit-ready moving forward. Participants will leave with clear guidance to strengthen compliance, reduce regulatory risk, and ensure defensible, high-quality care for residents.
Presenters
Luisa Vega
CEO | Psych Health Associates
About the Presenter
Dr. Luisa Vega, DNP, PMHNP, AGPCNP, was born in the Dominican Republic, and was raised in Puerto Rico. At age 18 she joined the U.S. military and served in the Army Reserves for eight years. Dr. Vega also worked for Verizon as a telecommunications Engineer in New York While working in the Verizon central office, she was directly exposed to the devastating events of 911 and its tragic aftermath. After working for six months in ground zero, she developed health conditions which propelled her to move to Florida to pursue a career in nursing. After completing her doctorate degree from Duke University, she became a geriatric nurse practitioner. She then attended Eastern Kentucky University where she obtained her post-master's degree and became a psych certified mental health nurse practitioner. In 2020 she partnered with Spectrum Medical Partners and launched Psych Health Associates, a behavioral health group that provides quality and compassionate psychiatric care to residents residing in skilled nursing facilities and assisted living communities.