GHS working to resolve threat of Medicare, Medicaid payment loss - FOX Carolina 21

GHS working to resolve threat of Medicare, Medicaid payment loss to Greenville Memorial

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Ad regarding Medicare and Medicaid at GHS (Source: The Greenville News) Ad regarding Medicare and Medicaid at GHS (Source: The Greenville News)
Greenville Memorial Hospital. (File/FOX Carolina) Greenville Memorial Hospital. (File/FOX Carolina)

A legal notice that ran in an Upstate newspaper on Tuesday has sparked concern from some Medicare and Medicaid patients.

The notice, which appeared to be posted by the Centers for Medicare and Medicaid Services (CMS) in The Greenville News, said after April 16, the Medicare and Medicaid programs will not cover hospital services for patients at Greenville Memorial Hospital.

CMS, part of the U.S. Department of Health and Human Services, said the hospital does not meet the conditions of the program's governing body, patient's rights or nursing services requirements.

According to figures released by GHS on Thursday, approximately 21,000 Medicare and Medicaid inpatients, or 59 percent of Greenville Memorial's inpatients, could be affected if they don't meet program requirements.

April Washington, spokesperson for CMS, said a survey was conducted on Mar. 13 at Greenville Memorial amid an ongoing criminal investigation involving the death of a patient.

Washington said CMS's first priority is to protect the health and safety of facility patients. She said GHS failed to ensure nursing and security staff followed policies for aggression management and restraint connected to the death of the patient.

According to Washington, security officers at Greenville Memorial failed to perform a safe takedown hold and the patient was not given a clinical assessment for an injection was administered.

She said the victim was placed face down on a bed and there was "no clinical assessment of the patient during the incident to ensure patient safety."

"The patient died while in a four-point restraint," Washington said.

On Mar. 6, the coroner said 48-year-old Donald Keith Smith died after being admitted to Greenville Memorial. According to the coroner, Smith became combative and a struggle ensued with security personnel.

Smith reportedly became unresponsive and stopped breathing. Efforts to resuscitate him were unsuccessful. His death was ruled a homicide due to traumatic asphyxiation. 

The South Carolina Law Enforcement Division is investigating Smith's death.

GHS will reportedly submit a corrective plan to the state, outlining steps to correct issues cited in the CMS survey.

A Greenville Healthy System spokesperson said the hospital is taking corrective steps to comply with CMS policy and they do not expect an interruption to Medicare or Medicaid services.

GHS issued the following statement:

Greenville Memorial Hospital (GMH) is making changes to improve processes in its emergency department following a site survey by the Centers for Medicare and Medicaid Services (CMS), which found that GMH was not in compliance with some CMS requirements. 

The survey came after GMH notified CMS that the hospital had identified potential areas for improvement in the emergency department.

“Nearly all action plan items have already been initiated, and we feel confident that CMS will find our plan – and its implementation – satisfactory,” said Scott M. Sasser, MD, GHS' chair of emergency medicine. “We do not anticipate any interruption of Medicare services, and we are committed to making improvements over and beyond what CMS requires. We’re proud of our public mission and the care we provide our community. GHS is absolutely committed to continuing to deliver high-quality care to every patient.” 

The broad areas of concern cited by CMS under its conditions of participation include nursing services, patient rights and the governing body. The GMH action plan for the emergency department includes strengthening clinical documentation processes around patient care, increasing staffing and providing more intensive training. 

“We take these issues very seriously and respect CMS’ judgment,” said Sasser. "Whether we have internal processes for improvement or have an opportunity presented to us by regulatory agencies, we welcome any opportunity to be better.”


The CMS notice applies to both Medicare and Medicaid patients. (We communicated this information incorrectly yesterday when we thought the notice applied only to Medicare patients. I apologize for the confusion.)

The notice is specific to Greenville Memorial Hospital. It does not affect any of the other hospitals that are part of Greenville Health System, nor does it affect any of our primary care physician practices or outpatient services outside of Greenville Memorial.

Based on Greenville Memorial Hospital’s FY 16 volume, roughly 21,000 Medicare and Medicaid inpatients could potentially be affected. This represents about 59% of Memorial's inpatients. The net revenue at risk from Medicare and Medicaid patients (both inpatient and outpatient net revenue for patients at Greenville Memorial) could potentially be approximately $495 million.

But, as Dr. Sasser stressed yesterday, we do not anticipate any interruption of Medicare services, and we are committed to making improvements over and beyond what CMS requires. 

Dr. Sasser addressed the negotiations at 3 p.m., saying the hospital is taking the situation "extremely seriously."

Sasser said they are using the feedback from the CMS survey to improve operations and patient care. Watch the full press conference here:

On Thursday, GHS released the following statement as an update in the ongoing situation:

At this time, the patients served by the  hospital are not in any immediate jeopardy of being moved or transferred to another facility. The hospital has an opportunity to take steps to correct deficiencies prior to termination, which takes effect April 16, 2017, as stated in their 23-day notice. In addition, the hospital has the right to appeal the decision within a 60-day period.  

It is important to note that most hospitals take the necessary steps to correct deficiencies prior to termination. 

The 23 day termination apply to the Medicare participating provider that can impact Medicare and Medicaid beneficiaries. The Immediate Jeopardy  determination is applicable to Medicare certification requirements.  However, if the hospital does not come into compliance, the state of South Carolina licensure requirements stipulate the provider must be Medicare certified to receive Medicaid funds.

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