Medicare rules on “never events”

August 19, 2022 | Crandall & Pera Law
Medicare rules on “never events”

Ohio Medicare patients and their families have experienced "never events" that resulted in medical malpractice claims. These unexpected incidents occur while patients are in hospitals or under the care of a healthcare provider in some capacity. Medical malpractice suits work to compensate parties injured by a "never event." "Never events" occur in cases the government says should never happen. The Center for Medicare and Medicaid Services (CMS) has implemented policies against "never events," although the reduction is evident, these events still happen repeatedly.

Medical malpractice and “never events”

Medical malpractice gives the injured party the right to claim damages for injuries or death sustained by an at-fault healthcare practitioner. CMS guidelines lift the financial obligation off patients that experienced a "never event." Eliminating the bill after a "never event" differs from damages received from a medical malpractice suit. Medicare patients are subjected to "never events" because of their age, condition, frailty, and mental state. Pressure ulcers are common "never events" when a patient lays or sits in one place for too long. The skin breaks, becomes infected, and could result in further injury or death. Staffing shortages or improper training increase these incidents, and healthcare facilities are held accountable in many cases.

Medicare and “never events” guidelines

CMS' Hospital Acquired Condition Policy (HAC) details the penalties for "never events" in healthcare facilities. The purpose is to keep Medicare patients safe and hold healthcare providers accountable. Financial penalties and improving best practices are the mission of HAC. Patient falls, UTIs, surgical errors, and others shouldn't occur according to CMS HAC guidelines but when they do it opens the door to medical malpractice claims. Over 760 hospitals received the 1% penalty for "never events." This number demonstrates improvements by hospitals to reduce incidents while providing cost-saving, effective patient care. Medical malpractice claims, in comparison, illustrate the need for further improvements. Wise counsel is an additional advocate for Medicare patients. Medical incidents occur, and many go unreported, especially in elder care. A watchful eye over your loved ones while in the hospital and an open line of communication with care providers reduces negligent care.