Martin hospital, Indian Health Service at odds

Martin, South Dakota (AP) July 2011

The director of a hospital in Martin warned it will have to close if the Indian Health Service doesn’t pay at least some of the nearly $1 million in emergency room bills for American Indians who choose the community hospital over an IHS hospital.

George Minder, chief executive officer for Bennett County Hospital and Nursing Home, said he has asked the Aberdeen Area IHS to pay at least $425,000 in past due bills, or about half of what he says is owed by the IHS since 2009 for care for residents of the Pine Ridge Indian Reservation in southwest South Dakota.

“If we don’t get Indian Health Service reimbursements, this facility will close,” Minder told the Rapid City Journal. “We’ll try to keep the nursing home open, but the hospital will close.”

Minder, who took over as hospital CEO in October 2010, said the situation went unaddressed for years but the money is needed to help meet a $135,000 bi-weekly payroll.

The director of the Aberdeen Area IHS, Charlene Red Thunder, said her agency is not responsible for those bills because they do not meet IHS guidelines to pay only for priority emergency care at non-IHS facilities.

Minder said the hospital is required under federal law to treat anyone who seeks emergency care and sees about 200 emergency room patients each month. He estimated at least 80 percent of them qualify for medical care from IHS.

When billed for those visits, IHS’s practice has been to deny all but Medical Priority I care claims under a policy of paying for emergency room charges at non-IHS facilities only for those typically defined as “threatening to life, limb or senses.” In denying other claims, the IHS said those patients could have sought care at the IHS hospital at Pine Ridge.

Minder said many residents of the reservation live closer to Martin than they do to Pine Ridge and some don’t have transportation to Pine Ridge, which is about 50 miles away.

In a prepared statement to the Journal, Red Thunder said IHS must ration its contract health service funds, which are used to pay for referrals or private sector medical care.

“If a patient goes to an outside provider without having a referral that is authorized and approved for payment by the CHS (contract health service) program, the patient is responsible for payment for those services and IHS is not liable,” she said. “By law, IHS is the payer of last resort, so patients and outside providers must use alternate resources first.”

Red Thunder said her agency has paid all of the Bennett County bills it owes but will continue to “provide education and technical assistance about its payment procedures.”