Leaked CMS Report Targets Medicare Noncompliance at CA Hospital


A leaked CMS report targeting HCA Healthcare-owned Good Samaritan Hospital in California warns the hospital to fix Medicare noncompliance issues or risk termination.

A leaked CMS report put HCA Healthcare-owned Good Samaritan Hospital in California at risk of program termination by October if they fail to fix Medicare noncompliance issues that resulted in patient harm. The report was leaked to NBC Bay Area’s investigative unit.

The report detailed numerous failures in leadership practices, poor nurse-to-patient staffing ratios, and inadequate staff training that resulted in missed patient assessments and delayed administration of medication to ICU patients at the San Jose hospital.

The hospital has until October 12, 2021 to become compliant with Medicare Conditions of Participation (CoPs). If the California Department of Public Health does not deem the hospital compliant by this date, its Medicare agreement will be terminated.

“When a hospital, regardless of whether it has deemed status, is found to be out of compliance with the CoPs, a determination must be made that the facility no longer meets the requirements for participation as a provider or supplier of services in the Medicare program,” the report explained.

“Such a determination has been made in the case of Good Samaritan Hospital and accordingly, the Medicare agreement between Good Samaritan Hospital and CMS is being terminated.”

Management oversights put “13 of sampled 37 patients at risk for adverse events,” the report revealed. CMS pointed to the hospital’s CEO, chief medical officer, and chief nursing officer to ensure that the hospital meets staffing needs and adequately trains nurses.

“The governing body failed to implement an effective system that provided for oversight of staffing and maintenance of a safe environment for all patients,” the report found.

“These cumulative failures resulted in the hospital’s inabilities to endure patient safety and quality of care.”

The report included the hospital’s responses and plans for corrective actions to remedy noncompliance issues, including assessing nursing staff each hour to anticipate staffing needs and rescheduling elective procedures when staffing needs cannot be met.

The nursing supervisor must now document staffing ratios twice daily and four months of auditing will ensure compliance, the report stated. The hospital also developed an education plan for emergency department and behavioral health staff related to adverse events.

Good Samaritan Hospital was found to be noncompliant by failing to learn from two adverse patient events by taking corrective action to prevent the events from happening in other areas of the hospital. The hospital failed to track negative patient care outcomes that resulted from staffing shortages, which could have jeopardized patient safety.

Staff were not re-educated on how to handle patients who were involuntarily hospitalized due to a mental health crisis, even after a patient was left in a bathroom alone with a high risk of self-harm.

In another instance, the hospital failed to implement regulatory policies by neglecting to validate an emergency technician’s competency prior to being hired, which resulted in unqualified staff delivering patient care. To combat this issue, the hospital established a process to ensure competency validation before employment.

Since receiving the notice of termination in July, HCA and the nurse’s union agreed to a new contract to combat staffing shortages. HCA also agreed to recruit 80 new nurses and 43 new nursing positions for both of the health system’s San Jose hospitals.

Another HCA Healthcare hospital is facing scrutiny this month. HCA-owned Mission Health in North Carolina was accused of running a monopoly business and hiking up hospital prices, insurance premiums, and out-of-pocket patient costs across western North Carolina.

HCA Healthcare is the largest for-profit hospital chain in the country, and monopoly concerns and noncompliance have federal agencies and patients looking for answers.

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