Medicare Won’t Pay for Some Preventable Complications

Joining a growing movement, Medicare on Oct. 1, 2008, will stop paying for serious complications that Medicare believes could have been prevented. 

The final list of these “serious adverse events” was published in the Aug. 19, 2008, “Federal Register.” The events are:

  • Pressure ulcers
  • Falls and trauma
  • Surgical site infections after bariatric surgery, certain orthopedic procedures, and bypass surgery
  • Vascular catheter-associated infections
  • Catheter-associated urinary tract infections
  • Blood incompatibilities
  • Air embolisms
  • Objects left during surgery
  • Some signs of poor control of blood sugar levels
  • Deep vein thrombosis or pulmonary embolism following total knee and hip replacements 

The Centers for Medicare and Medicaid Services (CMS) also sent a letter to state Medicaid directors on how they can adopt the same policy. In Pennsylvania, Medicaid already will not reimburse for surgery performed on the wrong body part or patient death or serious disability from a medication error. CMS is looking into making a national Medicare policy on wrong-site surgery. 

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Last Updated: 8/19/2008
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