Feds terminate UMMC Medicare contract; hospital appeals decision

Jan 21, 2024

Staff prepares to administer Covid-19 tests to people lined up at the United Memorial Medical Center testing site at the PlazAmericas shopping mall parking lot last month. Federal officials said they terminated Medicare contracts at United Memorial Medical Center after the Houston hospital system failed yet another federal inspection.

Federal officials said they terminated the Medicare contract with United Memorial Medical Center after the Houston hospital system failed yet another inspection.

The Centers for Medicare and Medicaid Services, which oversees the federal health insurance program for the elderly, said it will no longer reimburse United Memorial Medical Center for patients admitted to the small hospital system after Tuesday. The loss of Medicare would likely deal a crippling financial blow to United Memorial, which serves low-income neighborhoods and depends heavily on the federal reimbursements.

Contracts for Medicaid, the federal insurance program for the poor, are typically terminated following the loss of Medicare contracts. About 60 percent of United Memorial's patients are covered by Medicare and Medicaid.

Duni Hebron, the hospital spokesperson, said United Memorial is appealing the decision, and has filed for an emergency waiver. The waiver would allow the hospital to receive Medicare reimbursement for inpatient care because of the pandemic, and remain in effect until the appeal was resolved or the COVID-19 public health emergency ended, she said.

It's unclear when the waiver will be processed. In the meantime, the hospital said it will continue to see Medicare patients, even though it will not be reimbursed.

"We’re operating, and we have our revenues coming in, but yes, we’re concerned," Hebron said. "But again, we’re humans and we’re not going to throw people out. For now, we’re hopeful the waiver will be approved."

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United Memorial Medical Center has four locations in Greater Houston and 150 beds. It was on the brink of having its Medicare contract terminated about a month ago after failing four inspections between January and September 2021.

The Centers for Medicare and Medicaid Services, however, extended the termination deadline into January pending another inspection, which was conducted from Dec. 17-21. The hospital system failed again.

"Despite several opportunities to address their non-compliance, UMMC has failed to ensure the health, safety, and well-being of its patients," a CMS spokesperson said in statement. "Based on continued serious findings of deficiencies at this (Dec. 17-21) survey representing a failure to meet the minimum required quality standards, CMS issued an involuntary termination letter to UMMC on January 10, 2022, notifying the facility that its Medicare agreement will end on January 11, 2022."

The first four inspections found that staff did not have proper certifications for their jobs, and the hospital failed to screen staff for COVID-19. Inspectors also found rust on the wheels and casters of operating tables and stools and cockroaches in the operating room, among other deficiencies.

In the Jan. 10 termination letter, the Centers for Medicare and Medicaid Services said the most recent inspection found that the hospital's pharmaceutical services, surgical services, infection control and emergency services were out of compliance with federal standards.

A final inspection report with more details of the deficiencies won't be made available until early February, said a spokesperson for Centers for Medicare and Medicaid Services.

Hebron said the deficiencies found in the December inspection were mostly "administrative" issues, but declined to explain further.

United Memorial's campus on Houston's Northside is located in a zip code where the median household income is about $36,000, about half the median income for the Houston metropolitan area, according to census data. It also has locations in southwest Houston, Sugar Land and north of Beltway 8.

U.S. Rep. Sheila Jackson Lee, D-Houston, has worked with the hospital and federal officials to maintain the Medicare contract. She said she is sending letters to the president and has spoken to his staff regarding the hospital, its role in the community, and the importance of its Medicare and Medicaid contracts.

She emphasized that the hospital's flagship location is in a medical desert where there are few other health care options. The hospital's services, she added, are needed more than ever as the omicron variant drives a surge in COVID-19 cases.

"I’m hoping CMS can be sensitive and open minded with their own analysis, which had a lot to do with paperwork, signatures and the disposal of old and outdated medicine," Jackson Lee said. "All those things, I wholeheartedly believe, are crossing the ‘t's and dotting the ‘i's."

Although its agreement with Medicare was terminated, the hospital system may continue to provide services for the community, including COVID testing, vaccinations and outpatient services, according to the Centers for Medicare and Medicaid Services. United Memorial also could contract with other local hospitals to provide them additional beds during the public health emergency.

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