Medicaid Pulls Hospital Reimbursement for “Never Events,” Including Severe Bed Sores

By Nursing Home Law Center

Never Events Reimbursement

Medicaid has recently announced that it will no longer reimburse hospitals for “never events”, or 28 preventable conditions that should never happen in a qualified hospital. “Never events” include: falls that result in injury, catheter-related infections and severe bed sores (also called “pressure ulcers”). The new rules, mandated by the Affordable Care Act, went into effect July 1.

“These steps will encourage health professionals and hospitals to reduce preventable infections and eliminate serious medical errors”, said CMS Administrator Donald Berwick, MD, in a press release. “As we reduce the frequency of these conditions, we will improve care for patients and bring down costs at the same time”.

Currently, 21 states already refuse to reimburse “never events”. The remaining 29 will have up until July 1, 2012 to implement the new rules. States will also have the right to identify additional “preventable” conditions, for which Medicaid can be denied.

From my experience as a medical malpractice lawyer, I know that “never events” often indicate neglect and abuse. I can only hope that the new rules give more protection to the most vulnerable members of our society.

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