UMMC loses Medicare contract after regulators report 'substandard' care

CMS has terminated Houston-based United Memorial Medical Center's Medicare contract, effective Jan. 11, after failing to meet certain health and safety standards, a CMS spokesperson told Becker's on Jan. 12.

The hospital had four surveys between Jan. 8 and Sept. 10, 2021, in which the federal regulators found "substandard" quality of care, according to the spokesperson. 

CMS notified the hospital in November 2021 that the Medicare contract would be terminated Dec. 11 but extended the deadline to Jan. 11 with a pending follow-up inspection, partially because of a recent surge in COVID-19 cases.

The follow-up inspection occurred Dec. 17-21, the CMS spokesperson said. After finding that the facility failed to meet certain quality standards, CMS sent UMMC an involuntary termination letter Jan. 10.

"CMS has determined that United Memorial Medical Center no longer meets the requirements for participation in the Medicare program based on its noncompliance with Medicare Conditions of Participation and the Emergency Medical Treatment and Labor Act, including noncompliance that represents an immediate jeopardy to patient health and safety," the letter said.

As of Jan. 11, CMS is not paying for newly admitted patients. Additionally, 30 days after Jan. 11, it will stop paying for hospital services provided to Medicare and Medicaid beneficiaries, the spokesperson said.

UMMC is appealing the decision and filed for an emergency waiver to receive Medicare reimbursement during the COVID-19 pandemic, a UMMC spokesperson told the Houston Chronicle. The hospital will still see Medicare patients in the meantime without being reimbursed, the spokesperson said. 

UMMC did not respond to Becker's request for comment by the time of publication.

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