Medicare Refuses to Pay For Medical Mistakes And Doctor’s Negligence

Starting October 1, Medicare announced it will no longer pay for treatment resulting from medical errors which occurred during a hospital stay. What does this mean to the over 44 million Americans depending on the program for benefits? Basically, if you are further injured while in your doctor’s care, Medicare will not cover the additional costs associated with the treatment.

Medicare’s new policy is based on a list of "never events," which are theoretically never supposed to happen. When one of these events does occur, Medicare will no longer bear the burden and instead will require the hospital to report and pay for the error. The problem with these so-called "never events" is that over the years they have become more and more accepted by doctors as conditions that can and will occur. In fact, "never events" account for between 44,000 and 98,000 deaths each year. The "never events" list includes malpractice and negligent behavior such as foreign object left in body after surgery, operating on the wrong body part, falls and trauma, bed sores, infections at the surgical site, and other preventable problems.

This bizarre policy does not just apply to individuals under government aid, rather, several large private insurers including Blue Cross Blue Shield, Aetna, Cigna, and WellPoint have considered or implemented a similar "never events" system. The theory driving this policy is a pay-for-performance trend. Prior to this policy, there were practically no financial penalties for hospitals when a preventable "never event" occurred. Now, the hospitals are responsible for the costs associated with extended stay and extra procedures; the regulations forbid the hospitals from charging patients.

Although this policy is expected to save dollars and lives, the real question remains as to who will pay for the innocent patients’ additional pain and suffering and unnecessary time off work. Should the hospitals, doctors, or both be accountable? After all, if a doctor’s action (or lack thereof) meets one of the 28 conditions on the "never events" list, which in turn forces the hospital to cover the costs, is this evidence of negligent behavior or medical malpractice?