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Editor: Mike Bothwell
Profession: Qui Tam Attorney

Category: Qui Tam Legal News

Commencing in October 2008, New York hospitals will be denied reimbursement on 14 "never events" from the New York Medicaid program. "Never events" are defined as (a) avoidable hospital complications, including medical errors, (b) which are serious in consequences to patients, that are (c) identifiable and (d) preventable. In his announcement of the change, state Health Commissioner Richard F. Daines, M.D. stressed that this policy been put in place to improve healthcare quality, reduce medical errors and ensure patient safety.

The 14 "never events" currently listed are:

• Surgery performed on the wrong body part;
• Surgery performed on the wrong patient;
• Wrong surgical procedure on a patient;
• Foreign object inadvertently left in patient after surgery;
• Medication error;
• Air embolism;
• Blood incompatibility;
• Patient disability from electric shock;
• Patient disability from use of contaminated drugs;
• Patient disability from wrong function of a device;
• Incidents whereby a line designated for oxygen intended for patient is wrong item or contaminated;
• Patient disability from burns;
• Patient disability from use of restraints or bedrails; and
• Patient disability from failure to identify and treat hyperbilirubinemia (bilirubin in blood) in newborns

The list will continue to be modified and is expected to increase over time.

Commissioner Daines is concerned with patient safety and quality of care. He stated that "[p]atient safety is one of the nation's most pressing health challenges. Many insurers and hospital associations throughout the United States have reported 'never events' voluntarily, and adopting policies to heighten awareness about medical errors and to improve efforts to minimize the likelihood of such events. In addition, the federal government will be initiating a similar program for Medicare."

Hospitals that receive payment from the New York Medicaid program will now be required to provide information on each admission and determine which complications were present on admission and which complications happened during hospital care. This additional information will assist in Medicaid's determination of when payment for complications will be denied.