Physicians Accuse Hospital Chain of Fraud and Overbilling

Two whistleblower physicians accused HCA Healthcare and TeamHealth, both for-profit companies, of defrauding government programs by overcharging for care. The lawsuit was filed under seal in June 2022. The documents were unsealed April 6 of this year when the federal government declined to intervene.

HCA healthcare is based in Nashville, Tennessee, and operates 182 hospitals and more than 2300 care sites in 20 US states and the United Kingdom. HCA’s care sites include urgent care centers, walk-in clinics, surgery centers, diagnostic and imaging centers, and freestanding emergency departments (EDs). TeamHealth is a medical staffing company based in Knoxville and owned by Blackstone, a private equity company. This is not the first time TeamHealth has been sued for fraudulent billing practices, and HCA has previously been sued for similar practices as well.

Scott A. Ramming, MD, and Allen Lalor, MD, the physicians who filed the suit, were long-time employees of the then-nonprofit Mission Hospital System when the hospital was acquired by HCA in 2019. (Lalor has since retired.) In 2020, TeamHealth contracted with HCA to provide physician staffing at Mission Hospital.

At that time, according to the complaint, the hospital began a practice of intentionally overbilling public payers, such as Medicare and Medicaid, for unnecessary and wasteful services and supplies. Excessive and repeat lab tests, redundant CT scans and x-rays, and overuse of trauma alerts and/or codes are among the means routinely used to inflate billing, the suit alleges.

Lalor and Ramming allege that hospital managers “encourage and instruct” employees to order lab tests and scans on the basis of generic metrics called “powerplans,” rather than select lab tests and scans on the basis of clinical judgment after spending time with the patient. These metrics, they say, constitute a “humiliating relative ranking system that treats doctors like salesmen.”

In addition, the suit alleges that TeamHealth requires its physicians and nonphysician practitioners to see as many patients per shift as possible in order to increase revenue for the hospital. “While reducing physician time per patient helps [TeamHealth] reduce labor costs and increase charges, it very often does not serve to benefit the patient. Further, the incessant pressure to speed up interactions degrades the work environment and creates anxiety and stress among the team members and medical professionals who are involved,” the compliant states.

The complaint includes several examples of instances in which lab tests were repeated at Mission after they had been completed earlier in the day or the day before at another facility. In addition, nonurgent cases were treated as trauma cases.

In one case detailed in the filing, a 71-year-old patient who had fallen from a horse was transferred to Mission from another hospital. The first ED had performed extensive CT scanning, the full extent of the patient’s injuries was known, and the patient’s condition had been stable for hours before she arrived at Mission. Nonetheless, the case was given trauma designation upon her arrival.

Excessive cost cutting on the part of HCA has demoralized staff, led to overcrowding in the ED, and reduced quality of care, according to the complaint.

In a summary of a meeting from June 2020 that was included in the filing, ED physicians are instructed to make it a priority to see certain patients even if the appropriate specialist is present. “We need to own this territory,” reads one bullet point. Such statements “should be in the province of salesmen, not of emergency department medical professionals who are there to provide care for patients,” counters the complaint.

This approach is a direct result of the business model of corporate medicine, according to Mitchell Li, MD, who wrote an expert report that is included in the filing. Li is a practicing emergency medicine physician and founder of Take Medicine Back, an organization with a mission to bring public awareness to the corporate practice of medicine. “The pressures for profit are more extreme than we’ve seen in history. And that conflicts with the physician’s fiduciary responsibility to put patients first over profits,” Li told Medscape.

The problem is widespread, says Li, but few physicians speak up because they fear retaliation. In many cases, physicians who are employed by corporations have no right to due process; they can be fired at any time for any reason. This is particularly true of emergency physicians, Li explains. “I hear directly from physicians, constantly, who are afraid for their jobs. They’re afraid even to join my Take Medicine Back Facebook group because they fear retaliation from their employers.”

If the plaintiffs choose to continue their suit without the government’s involvement, the Department of Justice could get involved at a later date.

For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube.

Source: Read Full Article