On August 21, 2025, HHS OIG published a Data Brief, Report No. A-04-24-03003, which analyzed the frequency and outcomes for Medicare enrollees who chose to leave acute-care hospitals against medical advice (“AMA”). OIG found that Medicare enrollees are leaving acute-care hospitals AMA at steadily rising rates, which could have a negative effect on patient health outcomes and a negative financial impact on the Medicare program.
Among most of the demographics analyzed—including enrollee type, hospital size, population density, and medical condition—OIG reported finding the following:
- Rising Rates: The rate at which Medicare patients leave AMA from acute-care hospitals (in lieu of remaining for further care until discharge or transfer is medically advised) increased by nearly 50% between 2006 and 2023. The rate peaked during the COVID-19 public health emergency before dropping back down in 2023 to a rate still slightly higher than pre-pandemic levels.
- Poor Health Outcomes: Medicare patients who left AMA were more than twice as likely to be readmitted or die within 30 days of leaving AMA than patients discharged home.
- Hospital Quality Link: Lower-rated hospitals (based on the Medicare Star Rating System) saw higher rates of Medicare patients leaving AMA. Patients at the lowest-rated hospitals were nearly three times as likely to leave AMA as those at top-rated facilities.
- Vulnerable Groups: Dual-eligible beneficiaries (patients who are enrolled in both Medicare and Medicaid) and patients with mental health diagnoses were significantly more likely to leave AMA than other enrollees.
According to OIG, the purpose of this report is to serve as a resource for CMS and other stakeholders when conducting further research and developing guidance and best practices, because finding ways to reduce the rate of enrollees who leave AMA, or the poor outcomes these enrollees suffer when they do leave AMA, will likely improve the health of Medicare enrollees and save Medicare costs.
The full text of OIG Report No. A-04-24-03003 is available here.
