Discussion : Certification For Medicare & Medicaid
Your client is a hospital that has recently undergone a series of layoffs. A disgruntled former employee, a nurse, has complained to the state health department that the quality of patient care has suffered significantly. The hospital has had reason to be concerned about high rates of nosocomial infections (infections acquired in a hospital). There is also concern about bedsores and soiled linen. One patient’s open wound was infected by maggots. The nurse’s call to the state health department triggered a surprise inspection by the unit charged with overseeing certification for participation in the Medicare and Medicaid programs. It appears likely that the state Department of Health will seek summarily to terminate the hospital’s status under these programs as a “participating provider” (also known as the “provider agreement”). Consult the Code of Federal Regulations or one or more of the relevant practitioner treatises (e.g., the CCH Medicare and Medicaid Guide or the Aspen Hospital Law Manual) to determine what this means and what can be done about it.
- What financial, operational, and other repercussions is your hospital now subject to?
- What can you do to protect the interests of the hospital?
- What legal and regulatory factors are involved here?