By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On Monday, August 6, 2012, a New York Times article revealed that cardiology services at some Florida HCA hospitals are under investigation by the U.S. Department of Justice (DOJ) for allegedly performing unnecessary procedures to increase profits.
Click here to see the entire New York Times article posted August 6, 2012.
I previously blogged about and published an article on how a number of medical specialty societies have released lists of unnecessary or ineffective procedures.
To read that article, originally published in Medical Economics, click here.
The DOJ investigating Hospital Chain.
The report cites evidence that some HCA hospitals were performing unnecessary heart procedures for the sole purpose of driving up profits. According to the internal reports, some doctors allegedly made misleading statements in medical records to make it appear to subsequent reviewers that the procedures were necessary.
HCA said the Civil Division of the U.S. Attorney’s Office in Miami has asked for information about reviews that assess the medical necessity of some interventional cardiology services. The company also said the Civil Division of the DOJ has contacted HCA as part of a national review of whether charges to the federal government for implantable cardiac defibrillators met government criteria.
The DOJ indicated it will review billing and medical records at 95 HCA hospitals.
Details About the Procedures and the Company’s Knowledge of Them Were Found by the New York Times.
Details about the procedures and the company’s knowledge of them were found in thousands of pages of confidential company memos, e-mail correspondence among executives, transcripts from hearings and reports from outside consultants examined by The New York Times, as well as interviews with doctors and others. A review of the documents revealed that instead of questioning whether patients had been harmed or whether regulators needed to be contacted, hospital officials asked for information on how the physicians’ activities affected the hospitals’ bottom line profits.
HCA Posts Four-Page Response Letter on Its Website.
Prior to The New York Times story breaking, HCA posted a four-page letter on its website, explaining that The New York Times “appears to be making broad points concerning patient care provided at our company’s affiliated hospitals.”
The letter is complete with two pages of charts detailing totals for certain procedures performed at HCA locations.
According to the HCA letter, the decision on the necessity of some heart procedures is “the subject of much debate in the cardiology community.” It also states that based on Medicare inpatient data, trends concerning the number of cardiac catheterizations and percutaneous coronary interventions (PCIs) performed at HCA-affiliated hospitals compare closely to the rest of the nation.
To see the full letter from HCA, click here.
Cardiology Procedures Played a Large Role in HCA’s Profits.
Cardiology is apparently a booming business for HCA, and the profits from testing and performing heart surgeries played a critical role in the company’s bottom line in recent years.
Some of HCA’s busiest Florida hospitals performed thousands of stent procedures each year. Medicare reimburses hospitals about $10,000 for a cardiac stent and about $3,000 for a diagnostic catheterization.
Recently, doctors across the country have been slower to implant stents, instead relying on drugs to treat heart artery blockages. Medicare has also questioned the need for patients who receive cardiac stents to stay overnight at the hospital, cutting into the profitability of the procedures for many hospitals.
The Pressure is on to Root Out Medicare Fraud in All Hospitals.
The need to root out Medicare fraud is high for all hospitals, but the pressure on HCA is even greater. In 2000, the company reached one of a series of settlements involving a huge Medicare fraud case with the DOJ that would eventually come to $1.7 billion in fines and repayments. The accusations, which primarily involved overbilling, occurred when Rick Scott, Florida’s current governor, was the company’s chief executive. He was removed from the post by the board, but was never personally accused of wrongdoing.
As part of the settlement with federal regulators, HCA signed a Corporate Integrity Agreement that extended through late 2008. It detailed what had to be reported to authorities and outlined stiffer penalties if HCA failed to do so.
If there were intentional violations of such an agreement, it would mean “that a defendant, already caught once defrauding the government, has apparently not changed its corporate culture,” said Michael Hirst, a former assistant U.S. attorney in California in an interview with The New York Times.
To read the press release on HCA’s Corporate Integrity Agreement, click here.
Contact Health Law Attorneys Experienced in Handling Medicare Audits.
Medicare fraud is a serious crime and is vigorously investigated by the FBI and the U.S. Department of Health and Human Services (DHHS) Office of Inspector General (OIG). Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today.
The Health Law Firm’s attorneys routinely represent physicians, hospitals, medical groups, clinics, pharmacies, ambulance services companies, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.
To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Sources:
Creswell, Julie and Abelson, Reed. “HCA Discloses U.S. Inquiry Into Cardiology Services.” The New York Times. (August 6, 2012). From: http://www.nytimes.com/2012/08/07/business/hca-discloses-us-inquiry-into-cardiology-services.html
Murphy, Tom. “Justice Department Probes HCA Cardiology Care.” The Associated Press. (August 6, 2012). From: http://www.google.com/hostednews/ap/article/ALeqM5gXsDjWtOXgsrT_PKj5y-gwAyQCjg?docId=8cf91ec16d54407db6f93634099daef6
HCA. (August 6, 2012). From: http://hcahealthcare.com/util/documents/Information_Regarding_NYT_Story_080612.pdf
Justice.gov. “HCA -The Health Care Company & Subsidiaries to Pay $840 Million in Criminal Fines and Civil Damages and Penalties.” Department of Justice. (December 2000). Press Release From: http://www.justice.gov/opa/pr/2000/December/696civcrm.htm
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620
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