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Optalis Health and Rehabilitation of Troy

All states › Michigan › Troy › Optalis Health and Rehabilitation of Troy

925 W South Blvd Troy, MI 48085 · Oakland County

(248) 729-4400

All 2 nursing homes in Troy, MI (2 take Medicaid)

Cited for abuse Accepts Medicare Accepts Medicaid 160 certified beds For profit

CMS certification number 235626 · See this home on Medicare Care Compare

CMS abuse icon CMS marks this nursing home with its abuse icon. CMS shows the icon for homes with abuse citations in recent inspections: an abuse citation where residents were harmed (scope and severity G or higher) within the past year, or abuse citations at D or higher (potential for harm) in each of the last two years. Shown as of October 2026. Details on Care Compare.

Ratings come from CMS and are updated monthly; these are from October 2026. Check the latest inspection report and visit in person before you decide.

Is Optalis Health and Rehabilitation of Troy a good nursing home? Reviews, ratings and inspection record

There are no official resident reviews of nursing homes: Medicare's Care Compare publishes inspections, staffing and quality data instead. Here is what that record shows for Optalis Health and Rehabilitation of Troy as of October 2026.

CMS rates it 2 out of 5 stars overall, below the Michigan average of 3.2. Inspectors issued 65 citations in the last three years. CMS imposed 3 penalties, including $298,517 in fines, in that time. For short-term rehab patients CMS rates quality 5 out of 5; for long-term residents, 3 out of 5. Those results differ a lot, so ask about the unit your family member would be on. CMS currently shows its abuse icon for this home (see above).

Online reviews from families and residents are on Google Maps and other sites; they reflect individual experiences and aren't checked by CMS. The full inspection reports, including what inspectors observed, are on Medicare Care Compare.

Staffing

Nursing staff spend about 4.03 hours per resident per day at Optalis Health and Rehabilitation of Troy, above the Michigan median of 3.86 (US median: 3.72). About 0.60 of those hours are from registered nurses. On weekends it falls to 3.61 hours, 10% below its all-week average. 59.4% of nursing staff left within a year (Michigan median 43.8%). High turnover can mean residents see unfamiliar caregivers; ask how long the nurses on the unit have worked there.

Nursing care per resident per day 4.03 hours
Above the Michigan median of 3.86 Registered nurses, licensed practical nurses and aides combined, from payroll records.
Registered nurse hours 0.60 per resident a day RNs handle assessments, medications and changes in condition.
Weekend nursing care 3.61 hours Per resident a day. A big drop from weekdays can mean thin weekend staffing.
Nursing staff turnover 59.4% a year Share of nursing staff who left over a year. Lower usually means steadier care.
Registered nurse turnover 58.8% a year Share of registered nurses who left over a year.
Administrators who left 1 in the past year Frequent leadership changes are worth asking about on a visit.

About this nursing home

Certified beds160
Residents per day 107 About 67% of beds filled, on average
OwnershipFor profit - Corporation
Payment acceptedMedicare and Medicaid
Certified sinceFebruary 2007
Part of a chainOptalis Health & Rehabilitation
Legal business nameOPTALIS TROY OPCO LLC

Paying for care at Optalis Health and Rehabilitation of Troy: Medicare and Medicaid

Optalis Health and Rehabilitation of Troy is certified for both Medicare and Medicaid. Medicare Part A can cover a short skilled-nursing or rehab stay here after a qualifying hospital stay of at least three inpatient days (observation days don't count), for up to 100 days per benefit period. Medicaid can pay for long-term care for residents who meet Michigan's income and asset rules. Being certified doesn't guarantee a Medicaid bed is open, so ask whether the home accepts residents whose Medicaid application is still pending.

In 2026 Medicare covers days 1–20 in full after the Part A deductible ($1,736 per benefit period); for days 21–100 you pay $217 a day; after day 100 you pay all costs. Medicare doesn't pay for long-term custodial care. Medicare's coverage rules.

Health inspections

The most recent standard inspection was on March 11, 2026 and found 5 deficiencies, plus 9 from complaint inspections in the same period. In total, inspectors issued 65 citations in the last three years.

Each citation has a scope and severity letter from A to L. A–C: potential for minimal harm. D–F: potential for more than minimal harm. G–I: actual harm. J–L: immediate jeopardy to resident health or safety.

What the inspections found

Over the last three years, inspectors issued 65 citations at Optalis Health and Rehabilitation of Troy across 16 inspection dates, 38 of them from complaint investigations. 1 was at the immediate-jeopardy level (J–L), CMS's most serious category, most recently on June 16, 2026 (complaint inspection). The most common areas cited were quality of life and care (26) and resident rights (10). The most serious was cited under the CMS rule to "ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents" (tag F0689, level J, June 16, 2026). 8 citations were under CMS's abuse, neglect and exploitation rules.

June 16, 2026 · 1 citation · includes complaint inspection

JEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Immediate jeopardy · Quality of Life and Care Deficiencies · Tag F0689 · Complaint inspection · Deficient, Provider has date of correction (Jul 9, 2026)

March 11, 2026 · 8 citations · includes complaint inspection

FProvide and implement an infection prevention and control program.

Potential for more than minimal harm · Infection Control Deficiencies · Tag F0880 · Deficient, Provider has date of correction (Apr 2, 2026)

EHonor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0584 · Complaint inspection · Deficient, Provider has date of correction (Apr 2, 2026)

EProvide activities to meet all resident's needs.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0679 · Complaint inspection · Deficient, Provider has date of correction (Apr 2, 2026)

EEnsure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Potential for more than minimal harm · Pharmacy Service Deficiencies · Tag F0761 · Deficient, Provider has date of correction (Apr 2, 2026)

EImplement a program that monitors antibiotic use.

Potential for more than minimal harm · Infection Control Deficiencies · Tag F0881 · Deficient, Provider has date of correction (Apr 2, 2026)

EMake sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.

Potential for more than minimal harm · Environmental Deficiencies · Tag F0921 · Deficient, Provider has date of correction (Apr 2, 2026)

DEnsure services provided by the nursing facility meet professional standards of quality.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0658 · Complaint inspection · Deficient, Provider has date of correction (Apr 2, 2026)

DEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0689 · Deficient, Provider has date of correction (Apr 2, 2026)

March 2, 2026 · 1 citation, includes actual harm · includes complaint inspection

GProtect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Actual harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0600 · Complaint inspection · Deficient, Provider has date of correction (Mar 26, 2026)

December 30, 2025 · 1 citation · includes complaint inspection

DProvide appropriate treatment and care according to orders, resident’s preferences and goals.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0684 · Complaint inspection · Deficient, Provider has date of correction (Jan 22, 2026)

November 21, 2025 · 3 citations · includes complaint inspection

EProtect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0600 · Complaint inspection · Deficient, Provider has date of correction (Nov 30, 2025)

ETimely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0609 · Complaint inspection · Deficient, Provider has date of correction (Nov 30, 2025)

DEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0689 · Complaint inspection · Deficient, Provider has date of correction (Nov 30, 2025)

September 4, 2025 · 2 citations · includes complaint inspection

DProvide appropriate treatment and care according to orders, resident’s preferences and goals.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0684 · Complaint inspection · Deficient, Provider has date of correction (Nov 18, 2025)

DEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0689 · Complaint inspection · Deficient, Provider has date of correction (Nov 18, 2025)

June 25, 2025 · 1 citation, includes actual harm · includes complaint inspection

GProvide appropriate treatment and care according to orders, resident’s preferences and goals.

Actual harm · Quality of Life and Care Deficiencies · Tag F0684 · Complaint inspection · Deficient, Provider has date of correction (Jul 16, 2025)

April 9, 2025 · 9 citations, includes actual harm · includes complaint inspection

HProvide appropriate treatment and care according to orders, resident’s preferences and goals.

Actual harm · Quality of Life and Care Deficiencies · Tag F0684 · Complaint inspection · Deficient, Provider has date of correction (May 6, 2025)

HProvide enough food/fluids to maintain a resident's health.

Actual harm · Quality of Life and Care Deficiencies · Tag F0692 · Complaint inspection · Deficient, Provider has date of correction (May 6, 2025)

GEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Actual harm · Quality of Life and Care Deficiencies · Tag F0689 · Complaint inspection · Deficient, Provider has date of correction (May 6, 2025)

DHonor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0578 · Complaint inspection · Deficient, Provider has date of correction (May 6, 2025)

DProtect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0600 · Complaint inspection · Deficient, Provider has date of correction (May 6, 2025)

DTimely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0609 · Complaint inspection · Deficient, Provider has date of correction (May 6, 2025)

DRespond appropriately to all alleged violations.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0610 · Complaint inspection · Deficient, Provider has date of correction (May 6, 2025)

DProvide care and assistance to perform activities of daily living for any resident who is unable.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0677 · Complaint inspection · Deficient, Provider has date of correction (May 6, 2025)

DProvide medically-related social services to help each resident achieve the highest possible quality of life.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0745 · Complaint inspection · Deficient, Provider has date of correction (May 6, 2025)

February 19, 2025 · 1 citation · includes complaint inspection

DEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0689 · Complaint inspection · Deficient, Provider has date of correction (Mar 6, 2025)

December 11, 2024 · 14 citations · includes complaint inspection

EHonor the resident's right to organize and participate in resident/family groups in the facility.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0565 · Deficient, Provider has date of correction (Dec 28, 2024)

EEnsure services provided by the nursing facility meet professional standards of quality.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0658 · Deficient, Provider has date of correction (Dec 28, 2024)

EProvide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Potential for more than minimal harm · Pharmacy Service Deficiencies · Tag F0755 · Deficient, Provider has date of correction (Dec 28, 2024)

EEnsure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Potential for more than minimal harm · Pharmacy Service Deficiencies · Tag F0761 · Deficient, Provider has date of correction (Dec 28, 2024)

EProvide and implement an infection prevention and control program.

Potential for more than minimal harm · Infection Control Deficiencies · Tag F0880 · Deficient, Provider has date of correction (Dec 28, 2024)

DHonor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0550 · Deficient, Provider has date of correction (Dec 28, 2024)

DKeep residents' personal and medical records private and confidential.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0583 · Deficient, Provider has date of correction (Dec 28, 2024)

DNot transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0622 · Deficient, Provider has date of correction (Dec 28, 2024)

DProvide doctor's orders for the resident's immediate care at the time the resident was admitted.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0635 · Deficient, Provider has date of correction (Dec 28, 2024)

DProvide appropriate pressure ulcer care and prevent new ulcers from developing.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0686 · Complaint inspection · Deficient, Provider has date of correction (Dec 28, 2024)

DEnsure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.

Potential for more than minimal harm · Nursing and Physician Services Deficiencies · Tag F0726 · Deficient, Provider has date of correction (Dec 28, 2024)

DProvide timely, quality laboratory services/tests to meet the needs of residents.

Potential for more than minimal harm · Administration Deficiencies · Tag F0770 · Deficient, Provider has date of correction (Dec 28, 2024)

DArrange for the provision of hospice services or assist the resident in transferring to a facility that will arrange for the provision of hospice services.

Potential for more than minimal harm · Administration Deficiencies · Tag F0849 · Deficient, Provider has date of correction (Dec 28, 2024)

CPost nurse staffing information every day.

Potential for minimal harm · Nursing and Physician Services Deficiencies · Tag F0732 · Deficient, Provider has date of correction (Dec 28, 2024)

November 4, 2024 · 4 citations · includes complaint inspection

DHonor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0585 · Complaint inspection · Deficient, Provider has date of correction (Nov 20, 2024)

DTimely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0609 · Complaint inspection · Deficient, Provider has date of correction (Nov 20, 2024)

DEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0689 · Complaint inspection · Past Non-Compliance (Oct 22, 2024)

DGive their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0943 · Complaint inspection · Deficient, Provider has date of correction (Nov 20, 2024)

September 25, 2024 · 1 citation · includes complaint inspection

DHonor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0585 · Complaint inspection · Deficient, Provider has date of correction (Oct 15, 2024)

August 7, 2024 · 4 citations · includes complaint inspection

DDevelop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0656 · Complaint inspection · Deficient, Provider has date of correction (Aug 23, 2024)

DProvide care and assistance to perform activities of daily living for any resident who is unable.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0677 · Complaint inspection · Deficient, Provider has date of correction (Aug 23, 2024)

DProvide appropriate treatment and care according to orders, resident’s preferences and goals.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0684 · Complaint inspection · Deficient, Provider has date of correction (Aug 23, 2024)

DProvide safe and appropriate respiratory care for a resident when needed.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0695 · Complaint inspection · Deficient, Provider has date of correction (Aug 23, 2024)

June 25, 2024 · 2 citations · includes complaint inspection

DCreate and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0655 · Complaint inspection · Deficient, Provider has date of correction (Jul 11, 2024)

DProvide appropriate treatment and care according to orders, resident’s preferences and goals.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0684 · Complaint inspection · Deficient, Provider has date of correction (Jul 11, 2024)

May 20, 2024 · 3 citations · includes complaint inspection

DHonor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0585 · Complaint inspection · Deficient, Provider has date of correction (Jun 6, 2024)

DEnsure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit.

Potential for more than minimal harm · Nursing and Physician Services Deficiencies · Tag F0711 · Complaint inspection · Deficient, Provider has date of correction (Jun 6, 2024)

DProvide timely, quality laboratory services/tests to meet the needs of residents.

Potential for more than minimal harm · Administration Deficiencies · Tag F0770 · Complaint inspection · Deficient, Provider has date of correction (Jun 6, 2024)

October 26, 2023 · 10 citations · includes complaint inspection

FProcure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Potential for more than minimal harm · Nutrition and Dietary Deficiencies · Tag F0812 · Deficient, Provider has date of correction (Nov 15, 2023)

EAllow residents to self-administer drugs if determined clinically appropriate.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0554 · Deficient, Provider has date of correction (Nov 15, 2023)

EProvide appropriate treatment and care according to orders, resident’s preferences and goals.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0684 · Deficient, Provider has date of correction (Nov 15, 2023)

EEnsure each resident must receive and the facility must provide necessary behavioral health care and services.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0740 · Deficient, Provider has date of correction (Nov 15, 2023)

EProvide medically-related social services to help each resident achieve the highest possible quality of life.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0745 · Deficient, Provider has date of correction (Nov 15, 2023)

EImplement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.

Potential for more than minimal harm · Pharmacy Service Deficiencies · Tag F0758 · Deficient, Provider has date of correction (Nov 15, 2023)

DDevelop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0656 · Deficient, Provider has date of correction (Nov 15, 2023)

DProvide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0688 · Deficient, Provider has date of correction (Nov 15, 2023)

DEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0689 · Complaint inspection · Deficient, Provider has date of correction (Nov 15, 2023)

DEnsure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0693 · Deficient, Provider has date of correction (Nov 15, 2023)

Questions to ask on a tour of Optalis Health and Rehabilitation of Troy

  1. Inspectors cited the home at the immediate-jeopardy level on June 16, 2026 under the rule on quality of life and care. What changed afterwards, and can I see the plan of correction?
  2. CMS cited the home under its abuse and neglect rules on March 2, 2026. How are staff trained, and how are concerns reported?
  3. Nursing staff turnover was 59.4% a year. How many of the staff come from agencies?
  4. Do you have a Medicaid bed open now, and will you admit someone whose Medicaid application is still pending?
  5. When is the first care-plan meeting, and can family attend?

Questions come from this home's CMS data: its inspections, staffing and ownership record.

Fines and payment denials

3 penalties in the last three years, including $298,517 in fines.

DateTypeAmount or length
Jun 25, 2025 Fine $67,909
Apr 9, 2025 Fine $224,315
Oct 23, 2023 Fine $6,293

Rating history

CMS monthOverallInspectionStaffingQuality
October 2026 2/5 1/5 3/5 5/5
August 2026 2/5 1/5 2/5 5/5
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Location

Hospitals near Optalis Health and Rehabilitation of Troy

The Medicare-certified hospitals closest to this nursing home, with their CMS data. Ask the home which hospital it usually sends residents to.

Hospital ratings, ER visit times and more at Hospitals In Each State
Source: CMS Care Compare. Distances are approximate.

Nearby nursing homes

Pomeroy Living Rochester Skilled Rehabilitation Rochester Hills · 2.6 mi away ★★☆☆☆ Inspection 2/5 · Staffing 4/5 182 beds · Medicaid
WellBridge of Rochester Hills Rochester Hills · 2.8 mi away ★★★☆☆ Inspection 2/5 · Staffing 4/5 100 beds · Medicaid
Bellbrook Rochester Hills · 3.0 mi away ★★★★★ Inspection 5/5 · Staffing 5/5 36 beds · Medicaid
The Springs at Rochester Hills Rehab and Nursing Center Rochester Hills · 4.1 mi away ★☆☆☆☆ Inspection 1/5 · Staffing 3/5 126 beds · Medicaid
Optalis Health & Rehabilitation of Bloomfield Hill Bloomfield Hills · 4.3 mi away ★☆☆☆☆ Inspection 1/5 · Staffing 3/5 159 beds · Medicaid

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Other Optalis Health & Rehabilitation nursing homes in Michigan

Affiliation comes from CMS's affiliated-entity data, October 2026. All 36 Optalis Health & Rehabilitation nursing homes ›

Source: CMS Provider Data Catalog (provider information, health deficiencies, penalties), October 2026. Inspection citations and penalties cover the last three years. Nursing Homes In Each State is independent and not affiliated with CMS or Medicare. About the data · Report a problem with this listing. Is this your nursing home? Feature it here.

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https://www.nursinghomesineachstate.com/michigan/troy/optalis-health-and-rehabilitation-of-troy/ · Data: CMS, October 2026 · Nursing Homes In Each State, not affiliated with CMS or Medicare.