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Could It Have Been Prevented? If So, Medicaid Won't Pay Could It Have Been Prevented? If So, Medicaid Won't Pay

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Could It Have Been Prevented? If So, Medicaid Won't Pay

Left a sponge inside the patient? Transfused the wrong blood type? Don't look for the federal government to pay for fixing the mistake.

Medicaid will no longer pay hospitals or doctors for certain preventable illnesses and injuries, such as operating on the wrong body part, the Health and Human Services Department said Wednesday.


“These steps will encourage health professionals and hospitals to reduce preventable infections, and eliminate serious medical errors," Centers for Medicare and Medicaid Services Administrator Donald Berwick said in a statement.

"As we reduce the frequency of these conditions, we will improve care for patients and bring down costs at the same time.”

Medicare, the federal health-insurance plan for the elderly, already has such a policy—one widely recommended by health care experts as a way to help prevent expensive and deadly errors.


Medicaid, the joint state-federal health plan for the poor, will follow suit. Currently, 21 states already refuse to pay when health care providers make these mistakes. The 2010 health care law made it a federal policy and states have until July of next year to put the new policy into effect.

"This rule will help reward providers who provide high quality care to people in Medicaid leading to better care for patients and lower costs," CMS said.

Conditions and illnesses now no longer eligible for reimbursement include: foreign object retained after surgery, air embolism, blood incompatibility, severe bedsores, falls in the hospital that break bones, infections from having a catheter inserted, certain conditions from uncontrolled diabetes, and surgical site infections.

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