Ignite Medical Resort St Marys LLC
111 Mock Avenue, Blue Springs, MO 64014Map
Medicare/Medicaid certified130 certified beds~84 residents/dayFor profit - Limited Liability company
Last standard health inspection: August 27, 2024
Ignite Medical Resort St Marys LLC is a 130-bed for-profit, LLC-owned nursing home in Blue Springs, Jackson County, Missouri, serving an average of 84 residents per day. As of CMS data processed June 1, 2026, its overall rating is 2 of 5 stars.
CMS star ratings
CMS scores every nursing home 1–5 stars overall, built from three sub-ratings. moreless
Medicare inspects and measures every certified nursing home, then rolls the results into a 1–5 star overall rating. It combines three parts: health inspections, staffing, and quality measures. Five stars means much better than average — it does not mean perfect. One star means much worse than average — it does not mean every shift is bad. Stars are a screening tool, not a verdict. They can lag reality by months, and they can't see things like how kind the aides are or how the building smells at 7am.
What to do with this: use stars to build a shortlist, then visit in person. Nothing on this site replaces walking the halls.
Health-inspection stars are graded on a curve within each state — never compare stars across state lines. moreless
CMS sets health-inspection star cutoffs separately for each state: roughly the top 10% of homes in a state get 5 stars, the bottom 20% get 1 star, no matter how the state compares to others. That means a 4-star home in one state and a 4-star home in another state may have very different inspection records. The stars tell you how a home compares to its neighbors, not to the whole country. That's why this site shows your state's median next to each star rating — and never a national star comparison.
What to do with this: compare stars only between homes in the same state. To compare across states, use staffing hours — those are real numbers, not curves.
Not all three sub-ratings are equally hard to game: inspections are the most objective, quality measures the least. moreless
The three sub-ratings come from different sources. Health inspections are done on-site by trained state surveyors who show up mostly unannounced — the most objective signal. Staffing comes from payroll records that facilities must submit and CMS audits — quite reliable. Quality measures are partly self-reported by the facility from its own resident assessments — useful, but the facility grades some of its own homework.
What to do with this: when sub-ratings disagree, weigh the inspection star most and the quality-measure star least.
Staffing
Reported hours per resident per day, from payroll records. Hours, unlike stars, can be compared across states.
Hours per resident per day: total staff hours worked, divided by the number of residents. moreless
If a home reports 3.5 total nursing hours per resident per day, that's all nursing staff time across 24 hours — roughly one caregiver-hour every 7 hours per resident, spread across day, evening, and night shifts. On a real floor it decides whether call lights get answered in 5 minutes or 25, whether someone has time to help with dinner, and whether night shift is one aide for a hall or two. Unlike star ratings, hours are actual numbers, so they CAN be compared across state lines.
What to do with this: compare a home's hours to the state and national medians shown, and ask the facility how the hours split across day, evening, and night shifts.
RN (registered nurse) hours
LPN (licensed practical nurse) hours
Nurse aide hours
Total nursing hours
CMS also adjusts these numbers for how sick each home’s residents are — a home with sicker residents needs more staff for the same star. This home’s case-mix-adjusted total: 3.01 (US median, adjusted: 3.78).
CMS also adjusts staffing numbers for how sick each home's residents are. moreless
A home full of short-term rehab patients needs different staffing than a home caring for people with advanced dementia or ventilators. Case-mix adjustment estimates how many hours a home's particular residents need, then scales the reported hours so homes can be compared fairly. A home with sicker residents needs more staff for the same star. This page shows reported (raw payroll) numbers and compares them only to other reported numbers — like with like.
What to do with this: if a home's reported hours look low, check whether its residents may simply need less care — and ask the facility directly.
Staff turnover
Total nursing staff turnover: 52.1% · MO median: 56.1% · RN turnover: 44.4% (MO median: 50%)
The share of nursing staff who left within the year. Lower is steadier. moreless
Total nursing staff turnover is the percentage of the home's nurses and aides who stopped working there during the year. Around half of nursing-home staff leaving annually is sadly common in this industry. High turnover means residents are cared for by people who don't know them — which matters enormously for dementia care, pain management, and noticing the small changes that catch problems early. Low turnover usually means staff are treated well enough to stay.
What to do with this: when you visit, ask aides how long they've worked there. Long-tenured aides are the best sign a building has.
Inspections & deficiencies
The last 3 inspection cycles, from CMS’s federal health-survey file. State-only citations and fire-safety surveys are not included — an empty list means nothing federal is in this file, not that nothing ever happened.
Each deficiency gets a letter A–L: how severe it was × how widespread it was. moreless
Surveyors grade every deficiency on a grid. Severity runs from 'potential for minimal harm' up to 'immediate jeopardy to resident health or safety.' Scope runs from isolated (one or a few residents) to pattern to widespread. A and B are paperwork-level; D–F caused no actual harm but had the potential; G–I caused actual harm; J, K, and L mean immediate jeopardy — the most serious finding a surveyor can make. Most citations nationally are D–E.
What to do with this: scan for G or higher. One J/K/L tells you more than ten D's.
Standard surveys are routine; complaint surveys happen because someone reported a problem. moreless
A standard survey is the routine top-to-bottom inspection every home gets on a recurring cycle. A complaint survey happens because a resident, family member, or staff member reported something to the state — surveyors come specifically to investigate it. Infection-control surveys focus on practices like hand hygiene and isolation procedures. A deficiency found during a complaint survey means someone cared enough to report it and a surveyor confirmed enough to cite it.
What to do with this: note which deficiencies came from complaints — they show you what residents and families actually experienced.
The F-number on each deficiency is CMS's code for which federal requirement was violated. moreless
Every federal nursing-home requirement has a tag number. F0686, for example, is the pressure-ulcer requirement; F0600 is freedom from abuse. The tag tells you exactly which rule was broken, and the description next to it is CMS's own plain-language summary of that rule. The same tag appearing across multiple inspections is a pattern worth noticing.
What to do with this: if the same tag repeats across surveys, ask the facility what changed since the last citation.
This data shows federal health surveys only — state-only citations and fire-safety surveys aren't included. moreless
CMS's public deficiency file contains federal health-survey citations. It does not include citations issued under state-only rules, fire-safety (Life Safety Code) surveys, or anything older than three inspection cycles. A facility with no rows here may still have state citations or fire-safety findings. 'No deficiencies in this file' never means 'no violations ever.'
What to do with this: for the full picture, check your state health department's site and medicare.gov/care-compare, which shows fire-safety results separately.
35 deficiencies across the last 3 inspection cycles, in CMS’s federal health-survey file:
- Resident Rights: 9
- Quality of Life and Care: 9
- Nutrition and Dietary: 6
- Pharmacy Service: 3
- Environmental: 3
- Resident Assessment and Care Planning: 2
- Nursing and Physician Services: 1
- Freedom from Abuse, Neglect, and Exploitation: 1
- Infection Control: 1
August 27, 2024Standard surveyTag F0550D — no actual harm, potential for more than minimal harm, isolated
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Deficient, Provider has date of correction · corrected October 10, 2024
August 27, 2024Standard surveyTag F0554D — no actual harm, potential for more than minimal harm, isolated
Allow residents to self-administer drugs if determined clinically appropriate.
Deficient, Provider has date of correction · corrected October 10, 2024
August 27, 2024Standard + Complaint surveyTag F0584E — no actual harm, potential for more than minimal harm, pattern
Honor 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.
Deficient, Provider has date of correction · corrected October 10, 2024
August 27, 2024Standard surveyTag F0684D — no actual harm, potential for more than minimal harm, isolated
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Deficient, Provider has date of correction · corrected October 10, 2024
August 27, 2024Standard surveyTag F0686G — actual harm, isolated
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Deficient, Provider has date of correction · corrected October 10, 2024
August 27, 2024Standard surveyTag F0690D — no actual harm, potential for more than minimal harm, isolated
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Deficient, Provider has date of correction · corrected October 10, 2024
August 27, 2024Standard surveyTag F0695D — no actual harm, potential for more than minimal harm, isolated
Provide safe and appropriate respiratory care for a resident when needed.
Deficient, Provider has date of correction · corrected October 10, 2024
August 27, 2024Standard surveyTag F0699D — no actual harm, potential for more than minimal harm, isolated
Provide care or services that was trauma informed and/or culturally competent.
Deficient, Provider has date of correction · corrected October 10, 2024
August 27, 2024Standard surveyTag F0712E — no actual harm, potential for more than minimal harm, pattern
Ensure that the resident and his/her doctor meet face-to-face at all required visits.
Deficient, Provider has date of correction · corrected October 10, 2024
August 27, 2024Standard surveyTag F0745D — no actual harm, potential for more than minimal harm, isolated
Provide medically-related social services to help each resident achieve the highest possible quality of life.
Deficient, Provider has date of correction · corrected October 10, 2024
Show 25 more deficiencies
August 27, 2024Standard surveyTag F0756D — no actual harm, potential for more than minimal harm, isolated
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Deficient, Provider has date of correction · corrected October 10, 2024
August 27, 2024Standard surveyTag F0758E — no actual harm, potential for more than minimal harm, pattern
Implement 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.
Deficient, Provider has date of correction · corrected October 10, 2024
August 27, 2024Standard surveyTag F0804E — no actual harm, potential for more than minimal harm, pattern
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Deficient, Provider has date of correction · corrected October 10, 2024
August 27, 2024Standard surveyTag F0805D — no actual harm, potential for more than minimal harm, isolated
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
Deficient, Provider has date of correction · corrected October 10, 2024
August 27, 2024Standard surveyTag F0812F — no actual harm, potential for more than minimal harm, widespread
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Deficient, Provider has date of correction · corrected October 10, 2024
August 27, 2024Standard surveyTag F0813D — no actual harm, potential for more than minimal harm, isolated
Have a policy regarding use and storage of foods brought to residents by family and other visitors.
Deficient, Provider has date of correction · corrected October 10, 2024
August 27, 2024Standard surveyTag F0814D — no actual harm, potential for more than minimal harm, isolated
Dispose of garbage and refuse properly.
Deficient, Provider has date of correction · corrected October 10, 2024
August 27, 2024Standard surveyTag F0919E — no actual harm, potential for more than minimal harm, pattern
Make sure that a working call system is available in each resident's bathroom and bathing area.
Deficient, Provider has date of correction · corrected October 10, 2024
August 27, 2024Standard surveyTag F0921E — no actual harm, potential for more than minimal harm, pattern
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Deficient, Provider has date of correction · corrected October 10, 2024
October 25, 2022Standard surveyTag F0567E — no actual harm, potential for more than minimal harm, pattern
Honor the resident's right to manage his or her financial affairs.
Deficient, Provider has date of correction · corrected December 9, 2022
October 25, 2022Standard surveyTag F0568E — no actual harm, potential for more than minimal harm, pattern
Properly hold, secure, and manage each resident's personal money which is deposited with the nursing home.
Deficient, Provider has date of correction · corrected December 9, 2022
October 25, 2022Standard surveyTag F0607E — no actual harm, potential for more than minimal harm, pattern
Develop and implement policies and procedures to prevent abuse, neglect, and theft.
Deficient, Provider has date of correction · corrected December 9, 2022
October 25, 2022Standard surveyTag F0693D — no actual harm, potential for more than minimal harm, isolated
Ensure 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.
Deficient, Provider has date of correction · corrected December 9, 2022
October 25, 2022Standard surveyTag F0758D — no actual harm, potential for more than minimal harm, isolated
Implement 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.
Deficient, Provider has date of correction · corrected December 9, 2022
October 25, 2022Standard surveyTag F0814D — no actual harm, potential for more than minimal harm, isolated
Dispose of garbage and refuse properly.
Deficient, Provider has date of correction · corrected December 9, 2022
October 25, 2022Standard surveyTag F0919D — no actual harm, potential for more than minimal harm, isolated
Make sure that a working call system is available in each resident's bathroom and bathing area.
Deficient, Provider has date of correction · corrected December 9, 2022
January 14, 2020Standard surveyTag F0550D — no actual harm, potential for more than minimal harm, isolated
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Deficient, Provider has date of correction · corrected February 27, 2020
January 14, 2020Standard surveyTag F0567D — no actual harm, potential for more than minimal harm, isolated
Honor the resident's right to manage his or her financial affairs.
Deficient, Provider has date of correction · corrected February 27, 2020
January 14, 2020Standard surveyTag F0584E — no actual harm, potential for more than minimal harm, pattern
Honor 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.
Deficient, Provider has date of correction · corrected February 27, 2020
January 14, 2020Standard surveyTag F0623E — no actual harm, potential for more than minimal harm, pattern
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Deficient, Provider has date of correction · corrected February 27, 2020
January 14, 2020Standard surveyTag F0658D — no actual harm, potential for more than minimal harm, isolated
Ensure services provided by the nursing facility meet professional standards of quality.
Deficient, Provider has date of correction · corrected February 27, 2020
January 14, 2020Standard surveyTag F0661D — no actual harm, potential for more than minimal harm, isolated
Ensure necessary information is communicated to the resident, and receiving health care provider at the time of a planned discharge.
Deficient, Provider has date of correction · corrected February 27, 2020
January 14, 2020Standard surveyTag F0677E — no actual harm, potential for more than minimal harm, pattern
Provide care and assistance to perform activities of daily living for any resident who is unable.
Deficient, Provider has date of correction · corrected February 27, 2020
January 14, 2020Standard surveyTag F0695D — no actual harm, potential for more than minimal harm, isolated
Provide safe and appropriate respiratory care for a resident when needed.
Deficient, Provider has date of correction · corrected February 27, 2020
January 14, 2020Standard surveyTag F0880E — no actual harm, potential for more than minimal harm, pattern
Provide and implement an infection prevention and control program.
Deficient, Provider has date of correction · corrected February 27, 2020
Fines & penalties
CMS can fine a home or stop paying for new admissions. Shown per CMS's current data window (~3 years) — not all-time. moreless
When deficiencies are serious or aren't fixed, CMS can impose a fine (a civil money penalty) or a payment denial — refusing to pay for new Medicare/Medicaid admissions until the home fixes the problem. Payment denials hit harder than most fines because they stop revenue. CMS's public dataset covers a rolling window of roughly the last three years, so the totals here are recent history, not an all-time record. Many facilities have no penalties in the window — that's common, not remarkable.
What to do with this: a recent large fine deserves a direct question on your visit — what happened, and what changed?
No federal penalties in CMS’s current data window — many facilities have none; this is common.
Ownership & chain
Who actually owns and controls the facility — individuals, companies, and their stakes. moreless
Nursing homes are often owned through layers: an operating company, a property company, management companies, and individual investors with percentage stakes. CMS publishes who holds 5%-or-greater interests and who has operational control. Ownership matters because it sets the budget: research has linked some ownership structures, especially certain chains and investment vehicles, to lower staffing. That's a pattern across the industry, not a verdict on any one building.
What to do with this: know who owns the home before you sign anything, and ask the administrator who actually sets the staffing budget.
Part of Ignite Medical Resorts (24 facilities). Chain average overall rating: 2.6★ — this facility: 2★.
Most US nursing homes belong to a chain. The chain's average rating is context for this home's rating. moreless
A chain is a group of facilities sharing an owner or operator. Chains share budgets, policies, and management practices, so a chain's average rating tells you something about the company behind the building. A home rating well above its chain's average may have an unusually strong local team; one below it may be the chain's neglected building. Either way, the chain sets the constraints the local staff work within.
What to do with this: if the chain average is low, ask the administrator what this building does differently.
| Owner / manager | Role | Stake | Since |
|---|---|---|---|
| Ignite St Marys Jv LLC (Organization) | 5% or greater direct ownership interest | 50% | 11/01/2020 |
| Prestige Worldwide St Marys LLC (Organization) | 5% or greater indirect ownership interest | 10% | 11/01/2020 |
| Berger Fam Tr Ua 06252014 (Organization) | 5% or greater mortgage interest | NOT APPLICABLE | 03/01/2021 |
| Berger Fam Tr Ua 06252014 (Organization) | Adp of the snf | NOT APPLICABLE | 03/01/2021 |
| Blue Pearl Financial LLC (Organization) | Adp of the snf | NOT APPLICABLE | 03/01/2021 |
| Carr, Barry (Individual) | Adp of the snf | NOT APPLICABLE | 11/01/2020 |
| Carr, Jared (Individual) | Adp of the snf | NOT APPLICABLE | 11/01/2020 |
| Eddleman, Mindy (Individual) | Adp of the snf | NOT APPLICABLE | 11/01/2020 |
| Fields, Timothy (Individual) | Adp of the snf | NOT APPLICABLE | 11/01/2020 |
| Gillis, Karen (Individual) | Adp of the snf | NOT APPLICABLE | 11/01/2020 |
| Ignite Missouri Property Jv LLC (Organization) | Adp of the snf | NOT APPLICABLE | 03/01/2021 |
| Ignite Post Acute Solutions LLC (Organization) | Adp of the snf | NOT APPLICABLE | 03/01/2021 |
| Ignite Team Partners LLC (Organization) | Adp of the snf | NOT APPLICABLE | 03/02/2025 |
| Ignite-Villa Holdco LLC (Organization) | Adp of the snf | NOT APPLICABLE | 03/01/2021 |
| Israel Family Investment Trust (Organization) | Adp of the snf | NOT APPLICABLE | 03/01/2021 |
| Israel Investment Tr (Organization) | Adp of the snf | NOT APPLICABLE | 03/01/2021 |
| Jablonski, Nicole (Individual) | Adp of the snf | NOT APPLICABLE | 11/01/2020 |
| Luxe Staffing LLC (Organization) | Adp of the snf | NOT APPLICABLE | 11/01/2020 |
| Mcfarlane, John (Individual) | Adp of the snf | NOT APPLICABLE | 11/01/2020 |
| Prestige Worldwide Missouri Property LLC (Organization) | Adp of the snf | NOT APPLICABLE | 03/01/2021 |
| Rogers, Dylan (Individual) | Adp of the snf | NOT APPLICABLE | 04/01/2024 |
| Rose, Marc (Individual) | Adp of the snf | NOT APPLICABLE | 11/01/2020 |
| Spark Therapy LLC (Organization) | Adp of the snf | NOT APPLICABLE | 03/02/2025 |
| Stern Family Investment Tr (Organization) | Adp of the snf | NOT APPLICABLE | 03/01/2021 |
| Sudholt, William (Individual) | Adp of the snf | NOT APPLICABLE | 11/01/2020 |
| Thengil, Mathew (Individual) | Adp of the snf | NOT APPLICABLE | 11/01/2020 |
| White, Jim (Individual) | Adp of the snf | NOT APPLICABLE | 11/01/2020 |
| Carr, Jared (Individual) | Indirect ownership interest | NOT APPLICABLE | 11/01/2020 |
| Eddleman, Mindy (Individual) | Indirect ownership interest | NOT APPLICABLE | 11/01/2020 |
| Gillis, Karen (Individual) | Indirect ownership interest | NOT APPLICABLE | 11/01/2020 |
| Gobst, Ryan (Individual) | Indirect ownership interest | NOT APPLICABLE | 11/01/2020 |
| Gold Pearl, LLC (Organization) | Indirect ownership interest | NOT APPLICABLE | 11/01/2020 |
| Israel Investment Tr (Organization) | Indirect ownership interest | NOT APPLICABLE | 11/01/2020 |
| Jablonski, Nicole (Individual) | Indirect ownership interest | NOT APPLICABLE | 11/01/2020 |
| Mcfarlane, John (Individual) | Indirect ownership interest | NOT APPLICABLE | 11/01/2020 |
| Rogers, Dylan (Individual) | Indirect ownership interest | NOT APPLICABLE | 04/01/2024 |
| Thengil, Mathew (Individual) | Indirect ownership interest | NOT APPLICABLE | 11/01/2020 |
| White, Jim (Individual) | Indirect ownership interest | NOT APPLICABLE | 11/01/2020 |
| Berger, Aviva (Individual) | Individual is an owner, partner or trustee of any adp of the snf | NOT APPLICABLE | 02/28/2025 |
| Israel, Yehudis (Individual) | Individual is an owner, partner or trustee of any adp of the snf | NOT APPLICABLE | 02/28/2025 |
| Berger, Menachem (Individual) | Managing control - governing body | NOT APPLICABLE | 11/01/2020 |
| Carr, Barry (Individual) | Managing control - governing body | NOT APPLICABLE | 11/01/2020 |
| Fields, Timothy (Individual) | Managing control - governing body | NOT APPLICABLE | 11/01/2020 |
| Israel, Benjamin (Individual) | Managing control - governing body | NOT APPLICABLE | 11/01/2020 |
| Stern, Todd (Individual) | Managing control - governing body | NOT APPLICABLE | 11/01/2020 |
| Carr, Barry (Individual) | Operational/managerial control | NOT APPLICABLE | 11/01/2020 |
| Carr, Jared (Individual) | Operational/managerial control | NOT APPLICABLE | 11/01/2020 |
| Eddleman, Mindy (Individual) | Operational/managerial control | NOT APPLICABLE | 11/01/2020 |
| Fields, Timothy (Individual) | Operational/managerial control | NOT APPLICABLE | 11/01/2020 |
| Gillis, Karen (Individual) | Operational/managerial control | NOT APPLICABLE | 11/01/2020 |
| Ignite Team Partners LLC (Organization) | Operational/managerial control | NOT APPLICABLE | 11/01/2020 |
| Jablonski, Nicole (Individual) | Operational/managerial control | NOT APPLICABLE | 11/01/2020 |
| Mcfarlane, John (Individual) | Operational/managerial control | NOT APPLICABLE | 11/01/2020 |
| Rogers, Dylan (Individual) | Operational/managerial control | NOT APPLICABLE | 04/01/2024 |
| Rose, Marc (Individual) | Operational/managerial control | NOT APPLICABLE | 11/01/2020 |
| Spark Therapy LLC (Organization) | Operational/managerial control | NOT APPLICABLE | 11/01/2020 |
| Sudholt, William (Individual) | Operational/managerial control | NOT APPLICABLE | 11/01/2020 |
| Thengil, Mathew (Individual) | Operational/managerial control | NOT APPLICABLE | 11/01/2020 |
| White, Jim (Individual) | Operational/managerial control | NOT APPLICABLE | 11/01/2020 |
Nearby facilities in Jackson County
Most families compare 2–3 homes. Same county, sorted by overall rating:
Visiting? Go in with questions.
Built from this facility’s own CMS data — bring them on the tour.
- Their weekend total nurse staffing (2.73/resident/day) is lower than their overall figure (3.10) — ask who covers weekends and how shifts are filled when someone calls out.
- Their last standard health inspection was August 27, 2024 — ask what's improved since then.
- CMS records that this facility has a resident council — ask to speak with a council member before deciding.
- They have 130 certified beds and serve an average of 84 residents per day — ask which unit your person would be on and who staffs it overnight.
- They report 3.10 total nursing hours per resident per day (MO median: 3.37) — ask how those hours split across day, evening, and night shifts.
- CMS lists this facility as part of IGNITE MEDICAL RESORTS (24 facilities) — ask what the chain decides centrally and what this building's team controls.
Data: Centers for Medicare & Medicaid Services (data.cms.gov), processing date June 1, 2026. This site is not affiliated with CMS or any government agency.