Jennifer Smithfield felt weak and short of breath in February after nearly two weeks of treatment with covid-19. It was a 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 flagship hospital, near the company’s headquarters in Nashville, Tennessee, and thought she would be tested and sent home. But that’s not what happened.
“While I don’t feel well, I don’t think being hospitalized is that bad, especially not being hospitalized for days,” Smithfield said.
In three days, Smithfield paid $40,000 in fees for her inpatient stay and received a bill for $6,000 under the terms of her health insurance policy. Smithfield said: “I was able to get out. “I wish I had stepped out.”
She said, while in the hospital, the doctor who directed her to the emergency room texted her repeatedly, asking why she was hospitalized.
For more than a decade, major health systems have faced the scrutiny of costly hospital admissions when less expensive treatments or short observation times in the ER are Fit.
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Commercial insurers pay well for inpatient care, with room rates often running up to several thousand dollars a day – and that doesn’t include the fees that inevitably follow for blood draws. , counseling and other exams often occur. Hospitals, like hotels, maximize revenue by keeping their beds full.
Critics allege that HCA has sought to keep occupancy rates high by creating an incentive for doctors to admit ER patients — whether those patients require hospitalization or not. The allegation is particularly surprising because overall national hospitalization rates have fallen because more conditions can be safely treated with telemedicine and home monitoring.
US Congressman Bill Pascrell (DN.J.) and the Service Employees International Union pressed the Department of Health and Human Services to investigate allegations against HCA of potential Medicare fraud. Centers for Medicare & Medicaid Services spokesman Bruce Alexander said the agency is reviewing a September letter from Pascrell detailing allegations that HCA forces doctors to meet requirements. informal quotas or targets for the number of hospitalized patients. And a previously sealed whistleblower case is shedding light on such internal policies.
Pascrell, chair of the House Ways and Means oversight subcommittee, wrote to HHS Secretary Xavier Becerra: “Improper admission can have major effects on patients and workers. “Unnecessary hospitalization exposes patients to unnecessary treatments. This creates an additional risk of complications and the possibility of new infections for the patient.”
HCA spokesman Harlow Sumerford has denied the allegations. He told KHN in a statement: “We categorically reject any allegation that the physicians who admitted patients to our hospital were based on anything other than their independent medical assessment and patient’s condition and their medical needs.
Pascrell’s concerns are largely based on a 58-page SEIU investigative report published in February. The National Labor Federation has been challenging health systems over enrollment for more than a decade as it tries to organize more for-profit hospitals and campaign for members to work on the front lines. SEIU estimates HCA overcharged the Medicare program by at least $1.8 billion over about a decade through over-enrollment, according to the report.
Claims against HCA similar to those made by SEIU resulted in a $98 million settlement with the Public Health System in 2014 and a $262 million settlement in 2018 with the Health Management Associations . The government alleges that hospitals knowingly pay for inpatient services when lower-paid observational or outpatient services are warranted.
Jacob Tubbs, an attorney based in Birmingham, Alabama whose law firm Price Armstrong has represented plaintiffs in similar lawsuits against hospitals, said the government was in the best position to substantiate those claims. But he notes that demonstrating that doctors are leaving today’s standard of care systematically and willingly is difficult. It is especially difficult to show that a patient has been overtreated.
“The attorneys still have ‘a large amount of skepticism’ about their ability to win these cases,” he said. is not necessary.”
In a 141-page court filing from 2018, Dr Camilo Ruiz, a whistleblower at a 400-bed HCA hospital in suburban Miami, accused the health system of threatening his job if he didn’t take in more patients, instead of sending them home. from ER. HCA’s supervisors warned him to begin achieving the defined goals, he said in court documents.
Ruiz’s attorneys used publicly available Medicare data to show that HCA hospitals across the country routinely admit patients with minor medical conditions such as abdominal pain and lower respiratory problems. , dizziness and nausea while non-HCA hospitals send home patients with the same condition.
At 41 HCA hospitals with the highest hospitalization rates — located in Florida, Texas, Nevada, Virginia and California — attorneys found that between 2013 and 2016, 84% of Medicare patients were hospitalized for eight diagnostic routine, compared with 55% in non-HCA patients.
The Ruiz case was overturned in 2020 when the federal government refused to participate in the investigation. The Justice Department, which has intervened in similar cases that led to the settlement, did not explain in court documents why it approved the Ruiz case and declined to comment to KHN.
Ken Nolan is an attorney for Nolan Auerbach & White, a firm based in Fort Lauderdale, Florida, and has successfully represented whistleblowers alleging hospitalization fraud. Nolan said the government sometimes rejects cases for reasons other than a lack of evidence.
SEIU is continuing to push the government to investigate the allegations more broadly against HCA. The union incorporated data from the Ruiz suit in the report it procured for government agencies, including the Securities and Exchange Commission.
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In addition to requesting an investigation by HHS, Pascrell sent a letter directly to HCA’s CEO, Sam Hazen, asking for an explanation of the inflated enrollment numbers.
As the nation’s largest hospital company, HCA sets the pace for the US healthcare system. Its profits hit $7 billion by 2021 even as other health systems grapple with the pandemic’s headwinds.
For Smithfield, the expensive hospital stay is not only a threat to her wallet. It also discredited her in a system in which she had long received care, including treatment for leukemia. She is disputing her bill.
Now, as she seeks medical care, she wonders if “her best interests are being taken into account versus some other motive that hospital management may have.”
This article is from a collaboration that includes Nashville Public Radio and KHN.
Kaiser Health News is a national health policy news service. This is an editorially independent program of the Henry J. Kaiser Family Foundation not affiliated with Kaiser Permanente.
