An article in the New York Times (March 30, 2013) describes the impact of Medicare penalties based on patient admission rates, claiming that such schemes have resulted in decreased rates, from 19% to 17.8% in one year. But others claim that these measures are faulty because they unfairly penalize hospitals treating the sickest patients and those without appropriate after care such as housing, food and compliance with drug regimens. The penalties are set as 1% of hospital payments but are expected to rise to 3% in 2015. Should such disparities in the impact of penalties across hospitals be accepted as part of an effort to get overall cost reduction? Should there be standards regarding expected re-admits by criticality of patient to improve fairness ? Should hospitals be responsible for patient noncompliance ?