California hospital to lose Medicare contract

Stanislaus Surgical Hospital in Modesto, Calif., is facing a decision from CMS to end its Medicare contract, according to a termination notice from the federal agency.

The notice, dated April 11, said CMS will terminate the Medicare Provider Agreement with the hospital, effective April 30, because of the hospital's noncompliance with the Medicare Conditions of Participation. 

"A Medicare complaint validation survey conducted on Feb. 5, 2024, found Stanislaus Surgical Hospital was not in compliance with requirements for participation in the Medicare and Medicaid programs as established by the Social Security Act (Section 1861) and its underlying regulations," the notice said. 

The notice said CMS determined that Stanislaus Surgical Hospital was not in compliance with nine Medicare Conditions of Participation:

  • Basis and scope
  • Governing Body
  • Patient Rights 
  • Quality Assurance and Performance Improvement 
  • Medical staff 
  • Nursing services
  • Pharmaceutical services 
  • Surgical services
  • Anesthesia services

The hospital may legally contest the CMS order, Stanislaus Surgical said April 18, according to The Modesto Bee.

Stanislaus Surgical "plans to make every effort possible to continue providing high quality and important medical services to our community," a hospital statement shared with the newspaper said.

The CMS notice follows California Department of Public Health surveys in August and February, which found the hospital was not in compliance with certain Medicare conditions of participation, and focused on the hospital's handling of patient emergencies after surgeries as well as issues with infection prevention and control, sterilization processes, governance and use of certified nurse anesthetists in place of anesthesiologists, according to the Bee.

In its statement shared with the Bee, Stanislaus Surgical said it is "committed to the delivery of high-quality care to its patients. Given the level of engagement that SSH has had with CMS, and the efforts that we have made to drive operational excellence, the hospital is dismayed by the recent CMS decision to withdraw essential reimbursements for patient care. [Stanislaus Surgical] is exploring legal recourse to this action."

The CMS notice said "Medicare and Medicaid programs will not make payments for services furnished to patients who were admitted on or after April 30, 2024. For patients admitted prior to April 30, 2024, payment may be available for up to 30 calendar days after the effective date of termination."

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars