Health Law Daily Wrap Up, ACUTE INPATIENT HOSPITALS—OIG REPORTS: Hospitals see increase in inpatient Medicare enrollees leaving before discharge, (Aug 27, 2025)

By Leah S. Poniatowski, J.D.

Enrollees leaving against medical advice are significantly more likely to experience poor health outcomes, readmission, and death.

HHS’ Office of Inspector General (OIG) conducted an audit of Medicare enrollees admitted to acute-care hospitals for in-patient care and reported that the rates at which beneficiaries have been leaving hospitals against medical advice have been increasing since 2006, with a notable spike during the COVID-19 health emergency. Additionally, those that leave AMA are more than twice as likely to be readmitted or die following their initial inpatient treatment, which increases the cost of care (OIG Report, A-04-24-03003, August 2025).

Background. As part of its objectives, the OIG conducts analyses of collected data in order to discern patterns that can help stakeholders improve medical outcomes and reduce spending waste. In the study at issue, the OIG analyzed rates and outcomes of Medicare beneficiaries who had been admitted for in-patient treatment but left “against medical advice” (AMA), I.e., before a practitioner determined that they should be discharged from care. Evidence supports that those who leave before being discharged often are readmitted, die, or otherwise have poorer health outcomes and, thus, negatively impact the objective of improving the health of enrollees.

Relatedly, enrollees leaving AMA negatively impact efficient Medicare spending because the inpatient prospective payment system under the Social Security Act will pay an acute care hospital the full amount for in-patient care depending on the severity of the illness, regardless if the Medicare enrollee stays the full duration of expected treatment or not. Additionally, the cost of readmission and for unresolved health issues also increases when treatment is not completed.

Analysis. The OIG audited Medicare claim data from CMS’ Integrated Data Repository (IDR) from January 1, 2019 through December 31, 2023. The OIG noted that this period also included data from the COVID-19 emergency, and that data from before the audit period was reviewed in order to discern any trends over a longer period of time.

The OIG focused on Medicare Part A enrollees, among whom several were also beneficiaries of Medicaid. The diagnosis codes used in the study were those provided by the International Classification of Diseases, Clinical Modification, Official Guidelines for Coding and Reporting. The OIG also stated that the audit was performed according to the generally accepted government auditing standards, and provided details in an appendix to the summary.

Findings and conclusion. The first finding was that Medicare enrollees who leave in-patient care AMA have been increasing since 2006. The rate change from 2006 to 2019 was 0.68 percent to 0.99. During the COVID-19 medical emergency period, the rates spiked to 1.17, then dropped down to 1 percent in 2023. According to the OIG, the rate change appears to be consistent across key demographics.

The OIG also observed that the health outcomes for those who left AMA were worse than those who did not leave AMA. The data showed that the AMA enrollees were more than twice as likely to be readmitted to in-patient care or die within 30 days of leaving the hospital compared to enrollees who were formally discharged home. Another statistic the OIG discerned was that enrollees were more likely to leave AMA from a hospital with a lower quality rating by a factor of three. However, enrollees in both Medicare and Medicaid were more likely to leave AMA than a Medicare-only enrollee. Similarly, enrollees with a mental health diagnosis were also exiting care AMA at rates twice as high compared to those without a mental health diagnosis, regardless of the hospital’s rating.

Accordingly, the OIG concluded that Medicare enrollees leaving AMA continue to grow and are growing across the demographic board. Two areas of disproportionate rates, lower quality hospitals and enrollees with mental health diagnoses, highlight areas where stakeholders may focus when developing guidance for beneficiaries in these in-patient care settings.

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