The Florida attorney general's office is investigating allegations that as many as half of the cardiac operations at some of Floridas major hospitals are being performed needlessly.
The New York Times reported Monday that several internal reviews by the Hospital Corporation of America (HCA) have revealed that cardiologists at some of the health care giants institutions were unable to justify many of the surgeries they performed between 2002 and 2010. In some cases, the doctors seem to have justified these procedures by recording misleading diagnoses in medical records.
I have been in touch with Attorney General Pam Bondis office, and they have assured me that the Medicaid Fraud Control Unit is looking into this, Rep. Gayle Harrell, R-Stuart, told Sunshine State News.
Right now, all we have to go by is a news article. The Medicaid Fraud Unit is the appropriate mechanism for addressing these issues, and until we find out what exactly is going on, I do not see a need to propose any particular legislative action, said Harrell, who chairs the Health and Human Services Subcommittee of the Florida House of Representatives.
One of the hospitals mentioned in the Times piece, Lawnwood Regional Medical Center & Heart Institute in Fort Pierce, is located in Harrells district. A 2010 review by HCA found that about half of the hospitals invasive diagnostic procedures were done on patients without significant heart disease, according to the Times.
The review was prompted by a letter written to Lawnwoods chief ethics officer by a registered nurse. Though the review vindicated the nurses concerns, he was still fired from his job; the Times claimed to have reviewed an internal confidential memo by one of HCAs ethics officers, which revealed the termination of employment was retaliatory.
Abuses in overprescribing patients and overbilling Medicare and Medicaid are certainly a problem for us, said Rep. John Legg, R-Port Richey, in whose district lies the Regional Medical Center Bayonet Point in Hudson, Fla. The Times reported that an independent audit commissioned by HCA found that some 43 percent of the hospitals angioplasty cases, often risky surgeries where doctors operate to widen patients arteries, were outside reasonable and expected medical practice.
In some cases, doctors at Bayonet had documented the degree of patients artery blockages at 80 percent or 90 percent, when in fact subsequent studies found the blockages had ranged between 33-to-53 percent. Dr. Rita Redberg of the University of California, San Francisco, told the Times that cardiologists will generally not operate on blockages that are less than 70 percent. The substantial discrepancy between recorded and actual blockages raises real concerns that this wasnt just error, but it was intent by Bayonet doctors, she said.
Health care will definitely be a high priority for the Florida Legislature during its 2013 session, Legg said. [The Times expos certainly raises the profile of cases such as these.
Besides exposing patients to unnecessary risks including bleeding, inflammation, tissue damage, stroke, and death performance of unnecessary surgeries also passes burdens onto taxpayers.
I think it is common knowledge that there is a great deal of fraud in the health care system, particularly with regard to the major government-run programs, Medicare and Medicaid, Bob Sanchez, director of Public Policy at the Tallahassee-based James Madison Institute, told Sunshine State News. Many elected officials, notably including former U.S. Sen. Bob Graham, D-Fla., have sought to rein in the fraud not only the overbilling and the performance of procedures that were unnecessary and potentially risky, but also the payments for diagnostic tests that were never performed and for treatments that were never provided.
Southeast Florida, in particular, has been a hotbed of medical fraud, with fly-by-night clinics using bounty hunters to seek out patients even homeless persons camping under the expressways in order to use their identifying information to bilk the system. Unfortunately, despite the occasional successful prosecution, the fraudsters generally have managed to stay a step ahead of authorities. And, judging from the verdicts when some of these crooks actually were convicted, their schemes have cost the taxpayers and health insurers billions of dollars, Sanchez said.
Im a limited government guy, but when government programs and scarce public resources are at stake, greater and more effective state involvement and oversight is called for, said Legg. I expect leadership on this issue to be taken at the state rather than the federal level.
Asked whether he believed there were any state or federal laws or policies which enable these sorts of abuses, Legg replied, The risk [of fraud] is great whenever theres a third-party payment involved. I know when I personally pay my bills every month, I look over every line and every expense in great detail.
Sanchez agreed. The biggest factor these crooks have in their favor is the nature of medical billing. Third parties whether the government or insurers pay the bills while the patients, who logically could be expected to be more aware of the care that they did (or did not) receive, rarely are made aware of what the providers were paid, he said. It is a system with a high risk of fraud, and it can be expected to worsen under the Affordable Care Act as the health-care role of government bureaucrats grows.
According to a Bloomberg News story, the U.S. Justice Department is investigating 10 HCA hospitals, most of them in Florida.
This is not the first time the HCA hospital chain has made state or national headlines.
In 2000, the company paid a record $1.7 billionin fines and repayments in the largest Medicare fraud settlement in U.S. history. The accusations which inspired the suit, which primarily involved overbilling Medicare, occurred when now-Gov. Rick Scott was the companys chief executive. He resigned from the post under pressure by the board but was never personally accused of wrongdoing.
Scott offered no comment when asked about the Times report during a media conference Tuesday morning. Ive been away for 15 years, Scott simply replied. I saw the article in the paper. The alleged needless surgeries were not ordered until five years after Scott had left HCA.
Reach Eric Giunta at egiunta@sunshinestatenews or at (850) 727-0859.
