Two years ago, a nurse working for HCA, the largest for-profit hospital chain in the United States, sent a letter to the company’s ethics office claiming that physicians at one of the company’s hospitals in Fort Pierce, Fla., were performing unnecessary heart procedures in the catheritization lab, putting patients’ lives at risk.
The nurse, C.T. Tomlinson, did not get his contract renewed, most likely in retaliation for his whistle-blowing.
Tomlinson’s charges proved true, not just at the small Fort Pierce hospital, but at several of the company’s hospitals in Florida and a few in other states. According to an article in the New York Times ( http://www.nytimes.com/2012/08/07/business/hospital-chain-internal-reports-found-dubious-cardiac-work.html?_r=1&pagewanted=all), the civil division of the United States attorney’s office in Miami asked information in July concerning reviews of the medical necessity of interventional cardiology services provided at 10 of its hospitals.
Doing interventional cardiology procedures (most often the placing of stents in narrowed arteries) on people who don’t need it increases profits, and although it is less invasive than bypass surgery, it poses risks to patients. Arteries can be nicked or burst and patients can bleed out or go into cardiac arrest. The Times article recounts the misadventures of several such patients in HCA hospitals who very nearly died.
The motivator, of course, is greed: for each stent procedure, Medicare reimburses hospitals about $10,000; diagnostic catheterizations bring about $3,000.
The Times reviewed thousands of pages of memos, e-mails and other communications surrounding the investigation and found that the company’s concern was more about how this might affect the bottom line than on whether regulators needed to be notified or how patients’ health was affected.
HCA, by the way, is the company once headed by now-Gov. Rick Scott in Florida. Under his leadership in 2000, HCA reached one of a series of settlements involving a huge Medicare fraud case with the US Justice Department that would eventually come to $1.7 billion in fines and repayments. The accusations primarily involved over-billing, and Rick Scott wasdismissed by the board of HCA.
As part of the settlement with the federal regulators, HCA signed a 97-page agreement that extended through late 2008. It detailed what had to be reported to the government and provided for stiffer penalties if the company failed to report properly, which they appear to have done as early as 2002, according to the Times.
In 2003, the HCA hospital in Bayonet Point, Fla., was performing far more stent procedures than its population demographics would suggest. An investigation by an outside agency, completed in late 2004, found that nearly half — 43 percent — of stent procedures were “outside reasonable and expected medical practice,” according to the Times article.
Even worse, doctors were found to have falsified records to say patients’ conditions were far more serious than they actually were.
The Obama Administration is cracking down on Medicare and Medicaid fraud, and raking in millions of dollars in fines. It’s about time we all stopped turning our backs on this kind of fraud because, in the end, we all pay the price.