The HHS Office of Inspector General (OIG) has turned its attention to discharges against medical advice (AMA) with a recent letter asking some hospitals about claims coded that way and their supporting documentation. Exactly what’s driving the request from OIG’s Office of Audit Services isn’t clear, but AMA discharges have implications for quality of care, health equity, the two-midnight rule and readmissions, experts say.

OIG’s letter, which was signed by a regional inspector general for audit services, said OIG is doing survey work on discharges against medical advice. “We are contacting you because Medicare claims data indicates one or more claims that we will be reviewing have been coded as a discharge against medical advice by your facility. We may also be reviewing one or more claims not coded as a discharge against medical advice by your facility for comparison. For the claim(s) listed on the following enclosure(s), please provide all relevant documentation to support the claim(s), including documents related to the discharge planning, and any available clinical decision support documents that support the reason to discharge the patient or the reason why continued care was recommended at the time the patient left against medical advice.”

OIG also asked for policies and procedures related to patients leaving AMA. The information could include:

• “why and when to designate that a patient is leaving or has left against medical advice,

• “how to document and communicate this decision and designation, and

• “the discharge planning steps that should be completed or attempted when a patient leaves against medical advice.”