CMS looks to ban UnityPoint hospital's billing privileges over baby injuries

The CMS is planning to block one of UnityPoint Health's hospitals from billing Medicare after a spate of injuries in the newborn unit of its Madison, Wis., facility, ranging from bruises to bone fractures.

UnityPoint Health is a $4 billion system with 43 hospitals across Iowa, Illinois, Wisconsin and Missouri. The ban for UnityPoint's Meriter hospital was supposed to start March 18, according to a CMS notice sent to the hospital. However a agency spokeswoman said that the date has been moved to May 24 after the hospital made progress on some of the issues uncovered, but is still working on others.

"An immediate jeopardy was determined on regarding the facility's failure to develop and implement an effective policy to prevent suspected abuse related to injuries of unknown origin for patients in the newborn intensive care unit," the agency said in a report shared by the CMS with Modern Healthcare.

Since April of last year, Meriter officials have been aware that injuries were happening in its newborn unit but failed to thoroughly investigate, report and respond to any allegations of suspected abuse, the CMS said. As many as five infants have been hurt.

"The cumulative effects of these deficiencies resulted in an immediate jeopardy potentially affecting all patients in the newborn intensive care unit," the CMS said.

A spokeswoman for UnityPoint Health said Meriter was working cooperatively with the CMS to address its concerns.

In a correction plan submitted to the CMS, the hospital said it has suspended the suspected caregiver involved in the instances. A police investigation into the injuries has also been launched.

The hospital also is requiring all NICU providers and staff to be trained about policies and procedures for abuse and neglect reporting and caregiver misconduct reporting.

The hospital has also initiated a patient safety plan in collaboration with child protective services that involves increased patient monitoring by supervisors. In addition, two people will be present during all patient-care activities going forward.

Loss of the ability to bill Medicare would likely be a major blow. Of the $2.8 billion generated in patient revenue across all UnityPoint Health hospitals last year, just under $1 billion came from the government program, according to financial disclosure forms.