Hospital Defends Against Threatened Loss of Participation in Medicare Program

Hospital Defends Against Threatened Loss of Participation in Medicare Program

A security incident involved an emergency room patient in a local hospital while the patient was awaiting authorized transfer by ambulance to a regional facility. Despite handling the incident consistent with the hospital’s capabilities and policies, a complaint was lodged with the Centers for Medicare and Medicaid Services (CMS) and the state health department.

The complaint alleged an “immediate jeopardy” violation, which under CMS rules and Medicare conditions of participation, threatened the hospital with loss of its Medicare program participation within a 15-day period. We intervened, the threat of “immediate jeopardy” was lifted, and the matter was ultimately brought to a conclusion.

Because of this effort, we participated in a task force convened by the Minnesota Hospital Association (MHA) to address the issue of violent patients, and we presented on this topic to the MHA’s annual health care executive conference in 2009.