MedicaidCoverageMedium impact
Recovery of Inappropriate Payments for Non-Emergency Services Rendered in Emergency Departments
Maryland Medicaid·MD · Emergency Medicine·Hospital
We identified it
Jun 20, 2026
Summary
Maryland Medicaid will recover inappropriate payments for non-emergency services that were improperly rendered and billed in emergency departments. This policy targets situations where routine care was provided in an ED setting without meeting emergency criteria.
Action Required
Immediately: Emergency department billing staff must ensure all ED visits meet emergency criteria before billing. Review documentation requirements for ED services to verify medical necessity. Implement additional verification processes to prevent inappropriate ED billing for routine services that should be provided in outpatient settings. Failure to comply may result in payment recovery actions by Maryland Medicaid.