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New Federal Rule Quashes Medicaid Payments for Preventable Conditions

A new rule from the Centers for Medicare and Medicaid Services that became effective July 1st will not allow Medicaid funds to be used to pay medical providers for addressing injuries or illnesses that could have been prevented with proper care. Government spokesmen say the change will both improve patient safety standards and reduce costs.

Never Events among Conditions Warranting Nonpayment

Under the final rules, Medicaid will not be obligated to pay providers for any condition determined to be "reasonably preventable." However, there is also a much more clearly defined list of specific "never events" that indicates the type of conditions that will be excluded from Medicaid.

Never events got their name because they are medical mistakes that should never happen. Surgical operations performed on the wrong body part or patient, transfusing a patient with the incorrect blood type and certain surgical site infections are all never events. Falls, burns, and electric shocks that occur while in a hospital, catheter-induced urinary tract infections and the results of poor glycemic control also top the list. All told, there are approximately two dozen never events.

What It Means For Patients

The mere fact that Medicaid will no longer compensate medical providers for preventable mistakes and never events does not mean patients will be denied the care they need; Medicare has had a similar policy in place since 2008 and a drop in care standards has not materialized.

But, what will change is how patients may seek to cover their bills. A never event or a reasonably preventable medical mistake should give rise to a legal cause of action for medical malpractice. Any patient harmed by a health care provider's negligence can not only recover for any resulting medical costs, but also for other forms of damages, such as pain and suffering.

Payment of medical bills for never events will no longer come from Medicaid, but that does not mean Medicaid patients are left without recourse. If you or a loved one has been the victim of a health care error, contact a medical malpractice attorney today to explore your legal options.

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