The Rules of the Game

What happens if you violate the CMS rules, if you don’t follow the Hospital-within a-Hospital rules that they’ve set forth?  If you, for example, have board members that serve on both the El Paso Children’s Hospital Board and the UMC board?

“The OIG (Office of Inspector General) also has the discretion to impose exclusions on a number of other grounds. Excluded providers cannot participate in Federal health care programs for a designated period. An excluded provider may not bill Federal health care programs (including, but not limited to, Medicare, Medicaid, and State Children’s Health Insurance Program [SCHIP]) for services he or she orders or performs. At the end of an exclusion period, an excluded provider must affirmatively seek reinstatement; reinstatement is not automatic.” (underlining added).  (https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Fraud_and_Abuse.pdf)

This means that, at the discretion of the Office of the Inspector General, one or BOTH UMC and El Paso Children’s Hospital could lose the ability to participate in Federal Programs for a designated period of time.  Without those federal funds, either the hospitals would have to close their doors OR THE TAX PAYERS WOULD HAVE TO PONY UP MORE MONEY TO KEEP THEM AFLOAT!

With all of the choices presented to them through the 19 applicants that they received, why would the UMC and County Commissioner search committee elect to put both hospitals at risk by having an interlocking board member?

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