Skip to comments.Hospital Chain Said to Scheme to Inflate Bills (DOJ case against hospital)
Posted on 01/26/2014 5:07:06 AM PST by Red in Blue PA
Every day the scorecards went up, where they could be seen by all of the hospitals emergency room doctors.
Physicians hitting the target to admit at least half of the patients over 65 years old who entered the emergency department were color-coded green. The names of doctors who were close were yellow. Failing physicians were red.
The scorecards, according to one whistle-blower lawsuit, were just one of the many ways that Health Management Associates, a for-profit hospital chain based in Naples, Fla., kept tabs on an internal strategy that regulators and others say was intended to increase admissions, regardless of whether a patient needed hospital care, and pressure the doctors who worked at the hospital.
This month, the Justice Department said it had joined eight separate whistle-blower lawsuits against H.M.A. in six states. The lawsuits describe a wide-ranging strategy that is said to have relied on a mix of sophisticated software systems, financial incentives and threats in an attempt to inflate the companys payments from Medicare and Medicaid by admitting patients like an infant whose temperature was a normal 98.7 degrees for a fever.
(Excerpt) Read more at finance.yahoo.com ...
Twenty some odd years ago my Mother worked at the non-profit county hospital here in my small Texas hometown. It was sold to Hospital Corporation of America (HCA) and at midnight when the transfer of ownership took hold, the price of a bottle of sterilized water went from $2.30 to $23.75.
Meanwhile, Medicare and hospitals to charge facility fees, even work is NOT done in the hospital. Medicare overpays the charge and tells the hospital to rebill patients an additional $75!
Medicare Part D i nw charging my 92-year-old mother $16 for the same medicine she paid $0 last year. Same policy, too.
Im sure those who were not on board from the beginging or those who looked as though they were not going to play are now being targeted. This is how they operate and how they get even
More “frog and the scorpion” stories to come.
And then we have the government TriCare program where retirees can't get painkillers/antibiotics without a conference of doctors to insure that they really need them - the average attending physician in the Keesler AFB hospital can't prescribe much but over-the-counter meds w/o "consulting" a step or two above their levels.
The Obama DOJ run by Black leftist Holder has been searching for disgruntled employees ready to make wild claims inorder to shut down as many hospitals as they can.
Its all about getting back at White run corporations that did not donate to them.
But in this case.
HMA was being sold when this DOJ lawsuit was just spit out .
Its Pres Jarrett and Holders way to shake down millions to make it go away so the deal can go thru.
Its pathetic to see how many posters here instantly believe anything published in the Obama run media complex.
In the absence of top level oversight and a strong compliance effort by hospitals, small abuses tend to grow and compound until auditors or whistle blowers bring them to the attention of the federal government. Lawsuits and enforcement actions then result in paybacks, fines, operating restrictions, and management changes. Every now and then, someone even goes to jail.
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When “SOMEONE ELSE” is paying for it, there are no built-in price controls that a free market provides. No competition, no consumer choice... and yet this “right” to healthcare is upon us.
Screw this country.
You sound like a DU poster.
So HCA bailed a hospital that was broke and everyone kept there job including your mother.
Be grateful most hospitals never find a buyer and closed there doors.
Once the hospital closes it has a devastating rippling effect on a town.
Tell Ma to be happy the place stayed open.
Fraud and government money go hand in hand. The market rules, but when the government rigs the market the rigging rules and will be rigged, so to speak.
This is DOJ shakedown because this firm was being bought by CHS.Janet Reno did this all time and Holder learned from the master !
She would sue big companies just before a merger happened and leak stories to her Dem media pals and get millions so the lawsuit went away and the merger went thru.
This is The Evil White hating Holder we are talking about !
Many will find they do not meet 0’care regs, and will be forced to change or will go out of business, same goes for doctors and nurses. Which is why both parties want Amnesty bill to pass, they are importing your future ME Male doctor. Who have a woman bias. Been the victim of one in Oct. Bad English, not able to under stand it either.
HMA has been under scrutiny for some time and, based on the facts of the case, I think that improper influence by Holder is highly unlikely. Do you know of any evidence to the contrary?
If it was another administration I wouldn’t be suspicious. But hospitals do rip people oof. The assumption is insurance or taxpayers are paying for it. When I negotiated my surgery they immediately went down 50%. When I went line by line through the expenses there were dozens of charges for things I never used or my doctor requested. They got caught and they knew it
Our local hospital in a county of 30K+ was bought by the regional medical giant years ago. They then pressured every small private practice, using admitting privileges and subsidized malpractice, to join, locate their offices in the new Medical Arts building, and go to salary. The pensions of the workers in the former private practices were slashed. In-patient rooms were slashed. Wellness became the buzzword. There was the beginnings of an attempt to pressure massage therapists, athletic trainers and exercise instructors to join the Wellness Center, pay rent, pay for linen service and work for minimum wage. This failed, as did the plan to purchase a property for this Center. However, the community pool, initially paid for under a bequest, cannot pull in users and is simply a huge ongoing expense. The heated therapy lap pool survives. The PT department is kept on a tight reign, appointments limited per patient and is really just a gym where one-two PTs supervise 15 patients at a time, each limited to 3 sessions paid by insurance, the remaining sessions, if elected, billed so high, few can continue. The trendy and pricey restaurant established on-site, continues.
The ER charges went from $150 for a simple admittance only to $1000, plus a meds vending machine that took credit cards and overcharged, even during the daytime work week, even though there is a Walgreen’s and a Walmart in town and the hospital has a pharmacy. There were then at least a couple of unfortunate ER physician hires, one a foreign MD who was emotionally abusive to women and who refused to fill standing orders for meds without explaining to the patients that those meds were in shortage. Instead, he threatened them to never ever attempt to receive those pain meds in that ER ever again. Another ER hire was escorted out by LEO and everyone on staff has remained totally silent on the whys for the past 18 months.Prior to this, the area MDs all worked 1-2 shifts in the ER on rotation, so there was no need for Emergency Physicians as such. The ER was expertly run by a former military triage RN with more injury, trauma and surgical experience than any of the MDs.
There is an Urgent Care and a Wellness Clinic, separate from the ER. All the EMTs in this area are volunteer, supported by the townships. There are 2 outlying clinics that cater to low income, Amish and one is volunteer-staffed and free to the patient. The main major medical center is 45 miles away. Many, if not most, of its charges are rejected by most insurance companies on the grounds that they are too high. It is recognized as the most expensive medical center in the State.
Is it better than nothing? Sure. Is it as appreciated and beloved as it was prior to the sale? Of course not. As our older MDs retire, the new hires are all quite liberal and content to work under zer0care and all the new rules, including intrusive questioning, expensive initial appointments with PAs prior to being allowed an MD appointment and the clinic waiting room area is now like a tomb. Everyone says they are super busy, but the few times I have been there, it has been nearly empty, but there were still two desk attendants. The one time I was in the ER, there was one other patient, the various levels of clinician staff were rotated through their allowed procedures with each of us and spent the hour I observed mostly gossiping with the clerk at the ward desk. The real work I observed was done by a CNA.
This hospital was established over 50 years ago with a bequest. Our large number of clinicians in 5 private group practices and a few holdout individual ones, thrived. The clinical staff turnover has increased.
Bender2’s mom may have kept her job, but perhaps it became less of a calling. It isn’t the hospital that drives the town. Instead, a trendy private school draws in clinicians to the area. Without the hospital, these clinicians would still live here and either commute or would have joined/established private clinics. Instead, today, they are hired from the regional medical center and assigned here.
I had a MRI when I had appendicitis the hospital billed my insurance $8,000, the insurance paid $5400, they them proceeded to try to get me to pay an additional $540. I told them I would pay $40.00 which is 20% of what the service was advertised by a company in Dallas. They threaten my credit rating so I told them if they did that I wouldn’t pay them anything and would not use their facilities in the future. I got one more call and have never heard from them since. Last time I checked my credit there was nothing on it!!
Now, the hospitals and large healthcare providers, despite the efforts of their legal and compliance teams, will fall victim to government coding and rules entrapment. The government can pay and chase; set up confusing and conflicting rules, pay the provider, and chase them for fines, penalties and imprisonment.
I stopped taking Medicare since November 2011 because of pay and chase. In my case, we were using a 2010 code for a procedure and getting paid for every claim through 2011. The regional contractor never even changed the code on their website until September 2013. By law, the regional Medicare contractor is responsible for educating the provider and publishing changes on their website. In fact, they have algorithms built into their payment software that reject incorrect and old codes. The only reason that I found out that there was a coding change, was when I was stung with a Medicare audit.
Any provider, big or small, should EXPECT entrapment schemes to be used against them by Medicare.
ALL PROVIDERS MUST STOP TAKING MEDICARE AT ONCE.
The government is creating the environment for coding errors by promoting extreme complexity. Look at the proliferation of codes in ICD-10; this will do nothing to improve health care, but it will obviously create the opportunity for the government to threaten providers and take money back. Now, if you work in the compliance industry or in government, that’s a good thing for you personally in the short run, but this parasitic activity will eventually kill the host, aka, healthcare providers.
The answer is not better compliance teams for providers. Providers really need to critically look at either they should accept Federal health programs in the first place. And if they do accept Medicare et al, providers should take a critical approach that only accepts patients with very low coding risk and acceptable profit margins (which could mean very few or no Medicare patients).
The trend toward complexity in medical coding is all too real. The response that you suggest has been adopted by some providers but, by definition, cannot be embraced by more than a few or the health care system starts to implode. So far, the trend under Obamacare is of rising doctor compensation, probably because doctors are grabbing as much gold while they still can.
[ Twenty some odd years ago my Mother worked at the non-profit county hospital here in my small Texas hometown. It was sold to Hospital Corporation of America (HCA) and at midnight when the transfer of ownership took hold, the price of a bottle of sterilized water went from $2.30 to $23.75. ]
Heck Bendy i think that Hospitals should be able to treat illegals and then to bill their country of origin at 5X-10X their going rate and keep the prices low for us citizens!!!
But the government scheming to keep these same people out of the hospital is perfectly justifiable.
Our government is so F’d up.
In California they made big changes to the billing codes about 7-10 years ago. It was impossible to tell what the correct codes should be in some instances. Billing agents had to call the state to find out the right codes. And when they called the state, the state was vague and nonresponsive.
It’s all a big game out there. The government doesn’t like spending money on health care, and when it has a lock on it, the stuff is really going to hit the fan.
The game is all about entrapment of providers. What I’m doing now is recording all conversations that my billing staff has with insurance companies, and screen saving the websites that we are directed to by the insurance representatives. My billing staff always asks whether the individual on the line is a qualified representative of the company. BTW, we have one party consent for recording in WI. If we get into a dispute, the recordings are transcribed by a certified transcriber.
Good for you. I think that’s prudent.
Same thing happened with college tuition, they assumed student loans and taxpayers were paying for it.