Two Midnight Rule: Hospital Inpatient Designation Needs to Meet New Federal Medicare Requirements

As of October 1, 2014, to qualify for inpatient Medicare reimbursement rates, a physician needs to designate a patient’s condition to be serious enough to require at least two overnight stays. Those who are not eligible under those formal admission standards may remain in an outpatient or observation status. The knowingly improper designation of hospital inpatients, whether under existing Medicare rules or the new “Two Midnight Rule,” may be construed as Medicare fraud and result in False Claims Act liability.

More information for whistleblowers is located at the Nolan Auerbach & White website.