UMMC is days away from losing contract with Medicare and Medicaid

ByCourtney Carpenter KTRK logo
Thursday, December 2, 2021
Patients facing rejection as UMMC nears losing Medicare contract
From operating under dirty conditions, nurses not being up to date with certifications, and more, CMS argues the hospital is out of compliance with basic health and safety requirements.

HOUSTON, Texas (KTRK) -- United Memorial Medical Center, a hospital system with four Houston-area locations, is set to lose its contract with Medicare and Medicaid next week after the Department of Health and Human Services says the hospital has "deficiencies that represent immediate jeopardy to patient health and safety."

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

"In this instance, CMS has found that UMMC, despite proposed corrective actions, is out of compliance with CMS basic health and safety requirements. The hospital remains out of compliance with Medicare requirements after three follow-up surveys."

What does this mean for the patients on Medicare or Medicaid who go to UMMC?

Dietrich von Biedenfeld, an assistant professor of business law and supply chain management at the University of Houston-Downtown explains what it may mean come Dec. 11 when the contract is up.

"For those patients who have not already been accepted, or who might have been relying on those funds to cover their care, this means that within that framework, they will not have those reimbursed. They may be denied services that are non-emergency by the hospital," said von Biedenfeld.

CMS said UMMC is out of compliance when it comes to how some patient medical records are stored, along with operating with dirty rooms, violating fire safety rules, and more.

Rust and roaches were found in and near the operating rooms. In addition, some nurses are not up to date with certifications, among many pages of other infractions.

Von Biedenfeld explains arguably the most damaging infraction relates to governance, meaning CMS does not have confidence that the necessary improvements are going to be made.

"HHS lacks the trust in their governing bodies and mechanisms to insure that the other areas are going to be remedied, rectified or otherwise corrected in the time frames they've allowed based on repeated failures and based on repeated correspondence with detailed itemized lists of this is what you need to do," explained von Biedenfeld.

In one of the surveys conducted by CMS, they cited failure of the governing body because "a physician performed surgery on three patients without being officially appointed or granted surgical privileges by the governing body."

Another specific infraction was in regards to staffing, saying "a large percentage of agency/contracted RNs lacked documented ACLS and PALS certifications; two hospital locations had nursing directors in positions in which they did not meet the educational requirements; and the main campus did not have a director of nurses or an ED nurse director."

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

"If you think about this, there may not be, depending on their business model, an interest in actually appealing. So patients, in that regional area, may simply be out of luck as far as something convenient for these services until it's practical for them to either appeal for them to reapply," said von Biedenfeld.

Since last week, ABC13 has made multiple attempts to get an interview or statement from UMMC about the situation. Neither has been provided.