- Kansas-based Blue Valley Hospital nurses told CMS inspectors that they were asked to falsify patient health records to include medical complications that would justify keeping patients in the hospital longer to earn Medicare reimbursements, according to the Kansas City Star.
Nurses divulged this information to CMS inspectors in an April survey that resulted in the hospital losing its Medicare reimbursements.
While the nurses refused to carry out requests to falsify patient health records, inspectors found several other red flags in the hospital’s clinical and administrative processes — some of which compromised patient care delivery.
The four-bed care facility primarily provides bariatric procedures. After CMS revoked its certification to receive federal incentive payments, Blue Valley Hospital lawyers filed an appeal in district court to keep receiving reimbursements until the appeal is heard.
US District Judge Julie Robinson dismissed the hospital’s lawsuit against CMS, stating that the court system cannot become involved whenever a hospital is penalized for not complying with Medicare reimbursement regulations.
Furthermore, Robinson stated the case did not warrant any intervention from the court in light of the hospital’s failure to pass inspection.
"BVH was tagged with numerous deficiencies in both surveys, including compromise of patient care," Robinson explained. "As such, the government interest in protecting patients through an expeditious provider-termination procedure is quite strong.”
CMS stated Blue Valley Hospital did not treat enough patients or perform enough surgeries that require long inpatient hospital stays to qualify for the level of Medicare reimbursements it had been receiving as an inpatient hospital.
Additionally, CMS determined the hospital was not adhering to safe medication administration or clinical documentation practices.
"The re-survey found that BVH 'failed to use safe practices for medication administration and cited examples of failing to document or properly monitor medication administration, including medications that BVH routinely allowed patients to bring from home, leading to 'the potential for medication errors, drug overdose, adverse drug reactions, and ineffective medication management,” Robinson said.
Robinson added that Blue Valley Hospital leadership knew the facility was not adhering to federal regulations and took deceptive measures to falsely meet Medicare requirements.
The Blue Valley Hospital chairman of the board also told CMS inspectors the facility offered to absorb all out-of-pocket costs for employees and family members who qualified for weight loss surgery at the hospital to boost the number of surgeries and inpatient stays.
"Unfortunately, I have a lot of obese employees and they wanted this surgery," stated the chairman, according to CMS records. "So it was something that could help us both. We have done about 50-60 employee/family surgeries to date with about 70 more that want it."
Blue Valley Hospital officials said losing Medicare reimbursements could financially cripple the facility and force it to close its doors. Hospital officials also stated the loss of Medicare certification is due to a technical change in federal regulations rather than problems related to the quality of patient care delivery.
In a court filing, federal attorneys said the financial loss “is a risk BVH has assumed in basing its entire business model on government reimbursement.”
While Blue Valley Hospital officials are concerned losing Medicare reimbursements may deal a heavy financial blow to the organization, the hospital’s legal representatives told Kansas City Star that Blue Valley Hospital will continue business as usual.
"There has been no effect on existing patients and the hospital is still accepting new patients," Blue Valley Hospital attorney Curtis Tideman told Kansas City Star in an email. "Blue Valley Hospital is still very hopeful that this entire issue will be resolved quickly and appropriately."