Hospital pulled from federal Medicare program

Published 9:29 pm Tuesday, November 7, 2017

PINE RIDGE, S.D. — Recent documents show that the government’s decision to cut off Medicare and Medicaid payments to an Indian Health Service hospital in South Dakota was motivated by the case of a patient who the government said died after an inaccurate assessment.

A review by the Centers for Medicare and Medicaid Services said Pine Ridge Hospital inaccurately determined the severity of a patient’s condition, which allegedly led to delays in appropriate emergency care and his death.

The patient was transferred to another hospital several hours after being admitted, according to a triage assessment. The patient underwent surgery at the other hospital the next day, where he was diagnosed with extensive small bowel ischemia and necrosis. He died later that day.

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The department said Friday that the hospital’s participation in the federal Medicare program will end Nov. 18. The hospital won’t be able to bill the government for services provided to Medicare-enrolled patients. Medicaid payments will also be cut off.

The department’s review omitted significant details from the case, said Michael Toedt, chief medical officer for the Indian Health Service.

“The patient’s condition was improved on arrival to the tertiary care center due to the actions and treatment initiated at Pine Ridge Hospital,” Toedt wrote to the department Monday. “Many factors could contribute to the patient’s outcome, including comorbidities and care in another facility, and it is not possible to draw a direct conclusion from the care received at Pine Ridge Hospital to the patient’s ultimate outcome.”

Members of the Oglala Sioux Tribe on the Pine Ridge Reservation are provided with health care by the federal government pursuant to longstanding treaties. The Indian Health Service has funding from Congress to provide that care, the service obtains additional funding by enrolling qualifying indigenous patients in Medicare and Medicaid.

The department said in its notice of termination for the hospital that it is “closely monitoring the relocation of Medicare and Medicaid patients to other facilities.”