Medical Malpractice

If Medicare refuses to pay, is medical malpractice involved?

"This service cannot be paid when provided in this location/facility". This is written on the Medicare summary. Why would a government agency refuse to pay for a treatment in an ER? Is it possible that it is illegal to do certain procedures or to give certain drugs/medications in an ER? Medicare covered part of the claim but not the part for the drug.

Public Comments

1. The facility simply did not sign an contact with Medicare. There's nothing illegal about that, nor is there any indication of malpractice.
2. It could be that Medicare does not consider the specific service provided appropriate to a hospital E.R. (i.e., nonemergency services that should have been provided at a clinic or doctor's office) and therefore declines to pay the E.R. higher rates.
3. The Emergency Room may have lost its credentialling due to previous medicare fraud. That is happening a lot lately
4. Medicare considers an emergency as "an injury or illness that requires immediate medical attention to prevent a disability or death". They will not pay for procedures done if you went to the ER unless your problem falls into their definition of emergency even if it is a normally covered procedure. If it does fall within their definition it will be covered even if the hospital and the ER is not a Medicare approved facility.
5. No. Medical malpractice is when a doctor or other medical professional, misdiagnoses or mistreats you, causing you to get worse. PAYMENT has NOTHING to do with it. Medicare is NOT a carte blanche we pay for everything no matter what. If the provider does NOT accept medicare, then medicare won't pay them. They are not "in network" with Medicare. That means, YOU pay, if you go to that hospital. Sure, some procedures are illegal in er's. But that has NOTHING to do with payment.