5
0

Hospital chain allegedly admitted patients fraudulently to make more $$$


 invite response                
2012 Dec 2, 11:28am   41,860 views  43 comments

by curious2   ➕follow (2)   💰tip   ignore  

http://www.cbsnews.com/8301-18560_162-57556670/hospitals-the-cost-of-admission/

For more than a year, we have been looking into the admission and billing practices of Health Management Associates. It's the fourth largest for-profit hospital chain in the country with revenues of $5.8 billion last year, nearly half of that coming from Medicare and Medicaid programs. We talked to more than 100 current and former employees and we heard a similar story over and over: that HMA relentlessly pressured its doctors to admit more and more patients -- regardless of medical need -- in order to increase revenues.

Health Management Associates owns 70 hospitals in 15 states. It's thrived buying small, struggling hospitals in non-urban areas, turning them into profit centers by filling empty beds. Generally speaking, the more patients a hospital admits, the more money it can make, a business strategy that HMA has aggressively pursued.

« First        Comments 20 - 43 of 43        Search these comments

21   curious2   2014 May 8, 2:04pm  

APOCALYPSEFUCKisShostikovitch says

curious2 says

apocalyptic hyperbole

Hyperbole?

What?

Sorry - living in the SFBA fortress, I hadn't realized the cannibal anarchy was already upon us. Now I know, the cannibals are literally drugging pregnant women and cutting babies out of wombs in a grotesque feast of mammon, leaving these women scarred for life and overbilling every mandatory insurance customer and taxpayer for it all. Laughing in greed, with blood dripping from their teeth and sinews and umbilical cords hanging from their mouths, they snarl their appreciation for the mandatory insurance that enables them to disguise the hideous cost as a "benefit." (And yes, the feast had begun even before Obamacare; the legislation merely aggravates a pre-existing condition, force-feeding a glutton who was already morbidly obese.)

http://www.youtube.com/embed/R1m-AEWMRVo

http://www.youtube.com/embed/1kB67bTCz6M

22   MMR   2014 May 14, 7:28am  

Hospital went bankrupt in 2008 and was acquired by Prime Healthcare Associates. Later on they were upcoding malnutrition to kwashiorkor. 16.1% on medicare were diagnosed as having kwashiorkor, compared with 0.2% rate for the rest of California hospitals. Stories like that are the reason why Kamala Harris has basically prevented Prime Healthcare from acquiring more hospitals in California.....Reddy has friends on both sides of the aisle in California and now, I doubt the kwashiorkor rate is so high in Redding.

curious2 says

According to a previous report:

With 114 hospitals and $14 billion in yearly revenue, Tenet Health Systems is this country's second largest healthcare company.

It is also one of the most profitable, having built much of its business on critical care centers which specialize in expensive high-risk procedures, such as heart surgery... Tenet is now facing allegations that it made some of its profits from overbilling, false diagnoses, and - in at least one hospital - major surgery performed on patients who don't need it

One of Tenet's most profitable hospitals is Redding Medical Center, located in the shadow of Mount Shasta in Redding, Calif., a quiet town surrounded by farmland.

23   Ceffer   2014 May 14, 8:08am  

curious2 says

Laughing in greed, with blood dripping from their teeth and sinews and umbilical cords hanging from their mouths, they snarl their appreciation for the mandatory insurance that enables them to disguise the hideous cost as a "benefit."

Raw afterbirth is supposed to be good eatin'. Maybe they should start stocking the surgical suites with fromage and wine, as long as the docs don't eat the babies and charge for that, too.

24   curious2   2014 May 27, 12:50pm  

"Plano’s Baylor hospital faces hard questions after claims against former neurosurgeon"

It will be interesting to see how this story plays in Texas, where Karl Rove and GW Bush surfed to power on "tort reform." California has it too. It certainly has not reduced costs; to the contrary, the effect is to align the financial incentives all one way: do more billable procedures, without regard to risks. Thanks to malpractice insurance with community rating, the most unscrupulous operators offload their costs onto more careful practitioners, who cannot compete and are driven out of business.

25   Automan Empire   2014 May 28, 1:05am  

Yeah, don't even get started on dental chains whose business model is to hire indebted recent graduates and push unneeded procedures.

Procedures like filing down a 15yo girl's healthy natural teeth and installing crowns.

26   anonymous   2014 May 28, 1:16am  

"Yes, you do need braces"

27   anonymous   2014 May 28, 1:18am  

I awoke early this morning, to michelle obama scaling the side of our house with a pitchfork.

28   zzyzzx   2014 May 28, 3:48am  

elliemae says

Unnecessary equipment ordered for patients.

Obligatory:

29   Ceffer   2014 May 28, 4:43am  

Automan Empire says

Yeah, don't even get started on dental chains whose business model is to hire indebted recent graduates and push unneeded procedures.

Procedures like filing down a 15yo girl's healthy natural teeth and installing crowns.

In the heyday of Medi-Cal dentistry, the clinics in L.A. would send buses to the ghetto and engage in "capping" i.e. they would pay cash to the "patients" to drive them to the clinics for dental procedures to be billed to the state. It was eventually outlawed, but still, the patients were used as identity shills for billing purposes to tap the state funding. A few graduates became rapid millionaires by engaging their families in their practices with Medi-Cal fraud. Some were caught, others not. Like it or not, foreign graduates primed to exploit the idiot American welfare system were frequent offenders.

If you create a money spigot, there is always a genius who finds the most direct route to tap it come hell or high water, ethics or patient care out the window, it is why our insurance system and medical billing are crippled.

30   Ceffer   2014 May 28, 4:49am  

errc says

I awoke early this morning, to michelle obama scaling the side of our house with a pitchfork.

Michelle's fondest ambition is to scale Everest without oxygen and only a pitchfork. She will twerk decapitate her Sherpa on the summit.

31   anonymous   2014 May 28, 4:56am  

I spent all morning stringing slab bacon from the gutters like christmas lights to keep that deviant muslin witch from making her way atop the roof.

32   Ceffer   2014 May 28, 5:25am  

sbh says

Automan Empire says

Yeah, don't even get started on dental chains whose business model is to hire indebted recent graduates and push unneeded procedures.

Root planing is one such, and some hygienists are super pushy. The industry standard schedule for dental care they want to impose is akin to changing your engine oil every month. And even the receptionists feign insult when they aren't allowed to force appointments upon you. Going on an "as needed" basis is as frowned upon as fully paying off credit card balances each month. We aren't supposed to think for ourselves.

This is true, but one of the reasons is also that compensations for routine preventative care are negligible, don't cover office overhead and are bankruptcy bait, so the incentive is the "bill up" for survival if nothing else.

But again, that is part of the "broken" system where incentives and practices are awry.

35   Tenpoundbass   2014 Aug 18, 6:20am  

If you've got insurance you can get treatment you don't need. But even if you have cash, you can't get much desperately needed treatment without insurance.

I know I'm missing something, we just had healthcare reform for Christ sakes!

36   curious2   2015 Mar 15, 1:45pm  

37   MMR   2015 Mar 15, 3:43pm  

Ceffer says

paper mill

I call it insurance mill but paper mill is probably appropriate also

38   MisdemeanorRebel   2015 Mar 15, 4:30pm  

I wonder what/if insurance companies are allowed to own labs and testing facilities.

Insurance Companies own the labs, they jack up your labs' rates, then use the new higher rates to justify raising premiums on the insurance side.

39   curious2   2015 Mar 15, 5:32pm  

thunderlips11 says

Insurance Companies own the labs, they jack up your labs' rates, then use the new higher rates to justify raising premiums on the insurance side.

Yes, I got Disliked for pointing that out, but it's very common and it goes beyond labs. Insurance corporations and hospital corporations are merging, in order to shift revenue from one pocket to the other. The parent corporation raises fees at the hospital subsidiary in order to shift profits to the (unregulated) hospital side and away from the (slightly regulated) insurance side; as an added bonus, they can overcharge "out of network" and uninsured patients more than ever. Also, even "non-profit" hospitals that pay no tax may house for profit labs, with myriad opportunities for stock, options, and other revenue sharing incentives. This is a major factor driving unnecessary and injurious tests, including radiation that has nearly zero actual cost but can be billed for hundreds or even thousands of dollars. The typical Obamneycare enthusiast would rather roll his eyes than open them, so he sees either nothing or a dizzyingly skewed worldview.

40   carrieon   2015 Mar 15, 6:24pm  

No need to worry anymore. The IRS just decided to start auditing government spending and use the waste collected to pay off the national debt!

41   MMR   2015 Mar 15, 8:41pm  

MMR says

Prime Healthcare Associates

Looks like the DCHS Prime sale fell through....It's pretty much a done deal that those hospitals will have to declare bankruptcy.

http://www.healthcarefinancenews.com/news/report-prime-backing-out-daughters-charity-deal

While I don't like to call a billionaire a victim, especially one who has a spotty track record, Prime was the best candidate to keep the hospital open and honor the pension agreements of the SEIU workers. Instead of agreeing to 5-7 years running the hospital the way it was running (hemorrhaging money) she asked them to do that for 10 years. Prime Healthcare would be required to operate the hospitals as they are now, despite the fact that they are losing more than $10 million a month. "[The Daughters chain] would lose nearly $3 billion over the 10 years the conditions are in effect. Conditions dictate operations far beyond the scope of what is typical, including service offerings, financial reporting, governance, staffing levels, on-call coverage, seismic compliance and insurance contracts."

......One thing that isn't going to happen, Collis said, is Harris applying less stringent terms to any other buyer of the Daughters' chain. The best a buyer could hope for, he said, is that the attorney general might provide some relief down the road.

Translation: Prime was the best offer available, even if they would have cut some of the safety net operations of the hospital to stay afloat.....now the hospital will crash and burn and it will be interesting to see what effect that will have on the pensions of the SEIU rank-and-file.

http://www.latimes.com/opinion/opinion-la/la-ol-prime-daughters-of-charity-kamala-harris-20150310-story.html#page=1

This article represents essentially the first time Prem Reddy was ever spoken about in a positive light in the LA Times.

42   curious2   2015 May 18, 4:28pm  

Update: Even before they start in on fraudulent admissions, "Hospitals grab at least $1 billion in extra fees for emergency room visits"

« First        Comments 20 - 43 of 43        Search these comments

Please register to comment:

api   best comments   contact   latest images   memes   one year ago   random   suggestions