United Memorial Medical Center days away from losing Medicare and Medicaid contract

HOUSTON, Texas (KTRK) – United Memorial Medical Center, a hospital system with four locations in the Houston area, is set to lose its Medicare and Medicaid contract next week after the Department of Health and Human Services said the hospital had “impairments that pose an immediate threat to the health and safety of patients. “

Centers for Medicare & Medicaid Services, a division of the Department of Health and Human Services, issued the following statement:

“In this case, CMS discovered that the UMMC, despite proposed corrective actions, does not meet CMS’s basic health and safety requirements. The hospital still does not comply with the requirements of Medicare after three follow-up surveys. “

What does this mean for Medicare or Medicaid patients who come to UMMC?

Dietrich von Biedenfeld, assistant professor of business law and supply chain management at the University of Houston-Downtown, explains what that could mean on December 11, when the contract ends.

“For patients who have not already been accepted, or who could have relied on these funds to cover their care, this means that in this context, they will not be reimbursed. They may be refused non-urgent services by the ‘hospital,’ said von Biedenfeld.

CMS has stated that the UMMC is non-compliant when it comes to how certain patient medical records are stored, as well as operating with dirty rooms, violation of fire safety rules, etc.

Rust and cockroaches have been found in and near operating rooms. Additionally, some nurses are not up to date with their certifications, among many pages of other infractions.

Von Biedenfeld explains that arguably the most damaging breach relates to governance, which means CMS is not confident that the necessary improvements will be made.

“The HHS does not have confidence in its governing bodies and mechanisms to ensure that other areas will be corrected, rectified or otherwise corrected within the time frames they have allowed on the basis of repeated failures and on the basis of ‘repeated correspondence with detailed and itemized lists of this is what you need to do, “explained von Biedenfeld.

In one of the surveys conducted by CMS, they cited the failure of the governing body because “a doctor operated on three patients without being formally appointed or granted surgical privileges by the governing body.”

Another specific violation related to staffing, stating that “a large percentage of RNs / RNs under contract did not have documented ACLS and PALS certifications; two hospitals had nursing directors in positions where they did not meet training requirements; and the main campus didn’t have a director of nurses or an emergency director. “

The hospital could appeal or it could wait and reapply for the program.

“If you think about it, depending on their business model, there may not be an interest in being really attractive. So patients, in that regional area, may just be out of luck with anything practical for these services until it is convenient for either to invite them to reapply, ”said von Biedenfeld.

Since last week, ABC13 has tried on several occasions to obtain an interview or a statement from the UMMC on the situation. Neither has been provided.