Giant HCA hospital denies questionable admissions allegations | Tech US News


Jennifer Smithfield was feeling weak and still having trouble breathing in February after nearly two weeks of being sick with Covid-19. It was Sunday and her doctor’s office was closed. So her primary care doctor suggested going to the emergency room just to be safe.

Smithfield went to HCA Healthcare’s main hospital near the company’s headquarters in Nashville, Tennessee, thinking she would be examined and sent home. But that didn’t happen.

“Even though I didn’t feel well, I didn’t feel bad enough to be hospitalized, especially not for several days,” Smithfield said.

Within three days, Smithfield racked up $40,000 in hospital costs and received a $6,000 bill under the terms of her health insurance policy. “I could have left,” Smithfield said. “I wish you would go out.”

While she was in the hospital, the doctor who referred her to the emergency room texted her several times asking why she was admitted.

For more than a decade, large health systems have faced scrutiny for admitting patients to expensive hospital stays when less expensive treatment or short periods of observation in the emergency room would be appropriate.

Commercial insurers pay handsomely for hospital care, with room rates often running into the thousands of dollars a day—and that’s not including the costs that inevitably follow blood tests, consultations, and other routine checkups. Hospitals, like hotels, increase revenue by keeping beds full.

Critics argue that HCA has tried to maintain high occupancy rates by creating incentives for doctors to admit patients to the emergency room — whether those patients needed an admission or not. The allegation is particularly striking because admissions are generally declining nationally as more conditions can be safely treated with telemedicine and home monitoring.

Jennifer Smithfield reviews itemized billing statements from her time at HCA Healthcare.

U.S. Rep. Bill Pascrell (DN.J.) and the Service Employees International Union are pressing the Department of Health and Human Services to investigate allegations against HCA as potential Medicare fraud. A spokesman for the Centers for Medicare & Medicaid Services, Bruce Alexander, said the agency is reviewing Pascrell’s September letter detailing allegations that HCA forced doctors to meet unofficial quotas, or goals, on the number of patients admitted to the hospital. And a previously sealed whistleblower case sheds new light on such domestic policies.

“Improper hospital admissions can have cascading effects on patients and workers,” Pascrell, chairman of the House Ways and Means Oversight Subcommittee, wrote to HHS Secretary Xavier Becerra. “Unnecessary admissions expose patients to unnecessary treatment. This creates an additional potential risk of complications and the possibility of new infections for patients.”

HCA spokesman Harlow Sumerford denied the allegations. “We strongly reject any allegations that doctors admit patients to our hospitals based on anything other than their independent medical judgment and the individual conditions and medical needs of their patients,” KHN said in a statement.

Pascrell’s concerns are based primarily on a 58-page SEIU investigative report released in February. For more than a decade, the National Workers’ Union has challenged healthcare systems on admissions, trying to organize in more profitable hospitals and advocate for its members who work on the front lines. According to the SEIU report, HCA overbilled the Medicare program by at least $1.8 billion over about a decade due to overadmissions.

The claims against HCA are similar to those filed by SEIU, which led to a $98 million settlement with Community Health Systems in 2014 and a $262 million settlement with Health Management Associations in 2018. The government alleged that hospitals knowingly billed for inpatient services when lower-paid outpatient or observation services were warranted.

The government is in the best position to prove such claims, said Jacob Tubbs, a Birmingham, Alabama, attorney whose law firm Price Armstrong has represented plaintiffs in similar cases against hospitals. But he noted that it is difficult to prove that doctors have voluntarily and systematically deviated from today’s standard of care. It is particularly difficult to prove that a patient has been overtreated.

Lawyers still have a “healthy amount of skepticism” about the potential to win these cases, he said. “We know that ultimately we will have to prove that the medical care was objectively unnecessary.”

In a 141-page court filing from 2018, Dr. Camilo Ruiz, a whistleblower at HCA’s 400-bed hospital in suburban Miami, accused the health system of putting his job at risk if it didn’t admit more patients instead of sending them home. from the emergency room. HCA supervisors hounded him with warnings to start meeting set goals, he said in court documents.

Ruiz’s attorneys used publicly available Medicare data to show that HCA hospitals across the country routinely admitted patients for ailments such as abdominal pain, lower respiratory problems, dizziness and nausea, while non-HCA hospitals , sent patients home with the same illnesses.

At HCA’s 41 hospitals with the highest admission rates — located in Florida, Texas, Nevada, Virginia and California — the attorneys found that from 2013 to 2016, 84% of Medicare patients were admitted for eight common diagnoses, compared to 55% in hospitals without disease. -HCA hospitals.

The Ruiz case came to light in 2020 when the federal government declined to investigate. The Justice Department — which has intervened in similar cases that have led to settlements — did not explain in court filings why it referred the Ruiz case and declined to comment to KHN.

Ken Nolan is an attorney at Nolan Auerbach & White based in Fort Lauderdale, Florida and has successfully represented whistleblowers who allegedly committed hospital admissions fraud. Nolan said the government sometimes dismisses cases for reasons other than lack of evidence.

Jennifer Smithfield highlights the allegations she plans to contest in an itemized billing list from her time at HCA Healthcare.

SEIU continues to urge the government to investigate its broader allegations against HCA. The union included information from the Ruiz suit in a report it sent to government agencies, including the Securities and Exchange Commission.

In addition to asking HHS to investigate, Pascrell sent a letter directly to HCA’s executive director, Sam Hazen, demanding an explanation for the elevated admissions.

As the nation’s largest hospital company, HCA sets the pace for the US healthcare system. Its profits are approaching $7 billion in 2021 even as other health systems have struggled on the back of the pandemic.

For Smithfield, the expensive hospitalization didn’t just put her wallet at risk. It also shattered her trust in the system in which she had long received care, including treatment for leukemia. He is challenging his account.

Now that she’s seeking medical care, she wonders if “her best interests are being considered versus any other motive the hospital administration might have.”

This article is from a partnership involving Nashville Public Radio and KHN.


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