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


By curious2   Follow   Sun, 2 Dec 2012, 11:28am PST   7,158 views   48 comments
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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.

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curious2   Sun, 2 Dec 2012, 3:41pm PST   Share   Quote   Permalink   Like (3)   Dislike     Comment 9

And, no thread on "60 Minutes" medical reporting would be complete without this report showing whole categories of drugs (SSRIs) and surgeries (knee) to be no better than placebo:

http://www.cbsnews.com/8301-18560_162-57380893/treating-depression-is-there-a-placebo-effect/

This is part of why I conclude that most American medical spending consists of waste, fraud, and abuse.

curious2   Mon, 3 Dec 2012, 5:38am PST   Share   Quote   Permalink   Like   Dislike     Comment 10

Lest anyone accuse me of picking on hospital corporations (two of America's four largest cited above), while ignoring one of the other elephants in the room, I'll add a bit about PhRMA. Consider as a starting example Vytorin, widely advertised on TV; in clinical studies, "Vytorin failed to show much effect."

As is typical for drug trials that show failure, publication was delayed for years compared to trials that show "success", leaving the drugs on the market to make money, inflict side effects, and confer no benefit:

Newsweek: "Why Almost Everything You Hear About Medicine Is Wrong"

The literature imbalance can also result from the use of "rescue countries," i.e. if trials in America show a drug doesn't work, PhRMA can throw cash at doctors in dirt-poor "rescue countries" to produce "studies" showing "success":

Vanity Fair: "Deadly Medicine"

While much or most of current American medical spending consists of waste, fraud, and abuse, ObamaCare is projected to increase spending even further. It all adds up to what I hope might become a page in @Patrick's next book, The Medical Trap.

elliemae   Mon, 3 Dec 2012, 10:54pm PST   Share   Quote   Permalink   Like   Dislike     Comment 11

It is possible that spending will decrease, considering that grants to corporations for providing care to non-funded patients will eventually become unnecessary. Corporations won't be able to write off the free care on their taxes...

...of course, they'll find other ways to scam us all. I love this country!

curious2   Wed, 5 Dec 2012, 2:50pm PST   Share   Quote   Permalink   Like   Dislike     Comment 12

elliemae says

providing care to non-funded patients will eventually become unnecessary

LOL - In California, Obamacare is "threatening the financial stability of the state's safety net" because federal subsidies for illegal aliens will be diverted from public hospitals to insurance companies. Of course, the aliens are exempt from the mandatory insurance (they aren't even eligible if they want to pay for the insurance), and EMTALA will continue in effect so any remaining emergency departments will continue to be required to serve non-funded patients. So, existing emergency departments are closing and corporations are building new hospitals with no emergency departments at all. Letting injured emergency patients bleed to death may save $, but the savings will be more than offset by increased payments for toxic pills advertised on TV; federal projections show that ObamaCare will increase spending even above prior law, just as the lobbyists intended.

curious2   Tue, 16 Apr 2013, 1:25pm PDT   Share   Quote   Permalink   Like   Dislike     Comment 13

Two of today's headlines reminded me of the earlier reports in this thread.

The first is a report published in JAMA:

"When a privately insured patient experiences one or more complications -- such as blood clots, stroke, infection, septic shock, pneumonia or cardiac arrest -- hospitals' profit margins are 330% higher compared to a patient with no complications, the report found. For Medicare patients with complications, hospitals' profit margins are 190% higher, according to the report, which was published in The Journal of the American Medical Association."

The second is a federal investigation:

"At least two doctors at a Chicago hospital endangered patients by intentionally over-sedating them and performing unnecessary tracheotomies in a bid to boost profits, a graphic and wide-ranging complaint released by federal prosecutors Tuesday alleges.

The document doesn't directly say patients at Sacred Heart Hospital died as a result of the procedures that involve cutting a hole into someone's windpipe, but it notes mortality rates from one of the doctor's tracheotomies were far higher than average.

The investigation of the hospital dating back to 2011 led to arrests on Tuesday of the hospital's owner, Edward Novak, 58, of Park Ridge, as well as another executive and four doctors in an alleged conspiracy to exchange kickbacks for referral of patients insured by Medicare and Medicaid. The arrested doctors allegedly received kickbacks from the hospital totaling more than $225,000, the 90-page complaint said."

Guess who's looking forward to Obamacare, with "no lifetime caps!"

APOCALYPSEFUCKisShostikovitch   Tue, 16 Apr 2013, 1:30pm PDT   Share   Quote   Permalink   Like (4)   Dislike     Comment 14

Get paid to decapitate patients and spend millions tacking the heads back on!

curious2   Tue, 16 Apr 2013, 1:48pm PDT   Share   Quote   Permalink   Like   Dislike     Comment 15

In addition, "A California hospital chain has boosted its profits by transferring an unusually high number of patients from its emergency rooms to its hospital beds, gaining hundreds of millions of dollars by targeting people with Medicare, a California Watch investigation has found." (You can read more about that particular hospital chain, one of America's largest, from California Watch.)

Hospital corporations aren't alone in looking forward to Obamacare though: "California health insurers are proposing double-digit rate increases for hundreds of thousands of policyholders, drawing criticism that health insurers are padding their profits as the nation prepares to carry out the federal health care law."

BTW, @Bob2356, I'm sorry for putting you on Ignore, I was busy with tax forms and didn't have time for your distractions. I imagine you'll want to chime in on this thread with your usual refuted claims about all of this being "defensive medicine" and the solution being "tort reform" (i.e. making sure these hospitals and doctors shouldn't have to pay back any of the $$$ they overcharge for all these unnecessary injuries and/or deaths). Also, I updated my reply to your comment on a different thread, just wanted to let you know in case you wanted to respond. I do want to clarify though, by apologizing for ignoring you and giving you a chance to respond if you choose, I'm only trying to be fair. I don't share your T. Gondii-induced impulses to drive sideways at 80mph and surf with sharks and troll for fights all over the World Wide Web, but I do believe in giving people an opportunity to speak for themselves, or "enough rope" in other words, rather than ignoring them or whispering things about them behind their backs. Choosing ignorance says more about the person who chooses it than whatever they choose to ignore, so I'm sorry for briefly ignoring you. I can't promise to respond to all your comments though; if you wonder why, check my recent comment where I went out of my way to be nice and found an official link correcting your error about Medicare as gently as possible, and the thanks I got was only more sarcasm and rhetorical questions, no appreciation and not even an admission that you were obviously clearly wrong.

elliemae   Tue, 16 Apr 2013, 4:17pm PDT   Share   Quote   Permalink   Like (4)   Dislike     Comment 16

I see fraud all the time. Drives me fucking batshit crazy.

Home health companies who give kickbacks in order to get referrals for patients who don't need (or qualify for) the care.

Hospice patients who are signed onto service because they're referred, even though they're not dying.

Nursing homes that force patients into therapies they don't want - or need - in order to bill at a higher rate. patients who are rehabbed to death ( forced into rehab even while they're dying...)

Unnecessary equipment ordered for patients.

Ad nauseum.

curious2   Sat, 27 Apr 2013, 9:51pm PDT   Share   Quote   Permalink   Like   Dislike     Comment 17

BTW, just in case anyone remained unaware of drug companies paying doctors to prescribe profitably, here is yet another article on that: "US sues Novartis in NY again, cites doc kickbacks"

curious2   Sun, 16 Feb 2014, 12:39pm PST   Share   Quote   Permalink   Like   Dislike     Comment 18

Update: "The US Department of Justice has now joined eight whistleblower lawsuits against HMA.... Chief Executive Gary Newsom...retired last summer and now runs a Mormon mission in Uruguay."

mell   Sun, 16 Feb 2014, 1:08pm PST   Share   Quote   Permalink   Like (1)   Dislike     Comment 19

Related:

http://www.zerohedge.com/news/2014-02-15/drugging-america-summarized-19-mind-altering-facts

Ceffer   Sun, 16 Feb 2014, 4:02pm PST   Share   Quote   Permalink   Like   Dislike     Comment 20

Is there a drug I can take to stop worrying about all these drugs people are taking?

curious2   Sun, 16 Feb 2014, 4:24pm PST   Share   Quote   Permalink   Like   Dislike     Comment 21

Ceffer says

Is there a drug I can take to stop worrying about all these drugs people are taking?

IGNORITAL(TM) (disregardis onpurposis), "As Seen on TV." Homefool swears by it.

curious2   Wed, 26 Mar 2014, 4:51am PDT   Share   Quote   Permalink   Like   Dislike     Comment 22

Update: "1 in 25 patients gets infection in hospital... Patients acquired some 721,800 infections at hospitals [in 2011], according to the research. Of those infected, about 75,000 died, according to the U.S. Centers for Disease Control and Prevention -- although the study did not investigate how often an infection actually caused or contributed to the patient's death."

curious2   Thu, 8 May 2014, 1:25pm PDT   Share   Quote   Permalink   Like (1)   Dislike     Comment 23

"Hospitals performing too many unnecessary C-sections, Consumer Reports finds"

APOCALYPSEFUCKisShostikovitch   Thu, 8 May 2014, 1:36pm PDT   Share   Quote   Permalink   Like (2)   Dislike     Comment 24

curious2 says

apocalyptic hyperbole

Hyperbole?

What?

curious2   Thu, 8 May 2014, 2:04pm PDT   Share   Quote   Permalink   Like (1)   Dislike     Comment 25

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.)

MMR   Wed, 14 May 2014, 7:28am PDT   Share   Quote   Permalink   Like (1)   Dislike     Comment 26

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.

Ceffer   Wed, 14 May 2014, 8:08am PDT   Share   Quote   Permalink   Like (1)   Dislike     Comment 27

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.

curious2   Tue, 27 May 2014, 12:50pm PDT   Share   Quote   Permalink   Like   Dislike     Comment 28

"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.

Automan Empire   Wed, 28 May 2014, 1:05am PDT   Share   Quote   Permalink   Like (1)   Dislike     Comment 29

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.

errc   Wed, 28 May 2014, 1:16am PDT   Share   Quote   Permalink   Like   Dislike (1)     Comment 30

"Yes, you do need braces"

errc   Wed, 28 May 2014, 1:18am PDT   Share   Quote   Permalink   Like (1)   Dislike (1)     Comment 31

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

zzyzzx   Wed, 28 May 2014, 3:48am PDT   Share   Quote   Permalink   Like (2)   Dislike     Comment 32

elliemae says

Unnecessary equipment ordered for patients.

Obligatory:

Ceffer   Wed, 28 May 2014, 4:43am PDT   Share   Quote   Permalink   Like (2)   Dislike     Comment 33

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.

Ceffer   Wed, 28 May 2014, 4:49am PDT   Share   Quote   Permalink   Like (3)   Dislike     Comment 34

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.

errc   Wed, 28 May 2014, 4:56am PDT   Share   Quote   Permalink   Like (2)   Dislike (1)     Comment 35

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.

sbh   Wed, 28 May 2014, 5:19am PDT   Share   Quote   Permalink   Like (1)   Dislike (2)     Comment 36

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.

Ceffer   Wed, 28 May 2014, 5:25am PDT   Share   Quote   Permalink   Like (1)   Dislike     Comment 37

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.

curious2   Sat, 5 Jul 2014, 6:09am PDT   Share   Quote   Permalink   Like (1)   Dislike     Comment 38

"Consumer group urges hospitals to stop 'unethical' health screenings... "It is exploitative to promote and provide medically non-beneficial testing through the use of misleading and fear-mongering advertisements in order to generate medically unnecessary but profitable referrals to the institutions partnered with HealthFair," said Dr. Michael Carome, director of Public Citizen’s Health Research Group." Public Citizen highlighted HealthFair’s cardiovascular screening package, which includes taking pictures of the heart, measuring electrical activity and looking for blockages in arteries, among other tests."

curious2   Mon, 18 Aug 2014, 5:57am PDT   Share   Quote   Permalink   Like   Dislike     Comment 39

"The healthcare industry has frequently been criticized for poor security practices in recent months. In April, the FBI issued a warning to healthcare providers regarding potential security weaknesses, and several security reports have highlighted the same threats.

According to a recent report from BitSight Technologies, healthcare and pharmaceutical companies have the lowest security performances when compared to the finance, utility and retail sectors.
***
The [latest reported] breach, which is believed to have originated from a Chinese hacker ring, resulted in stolen personal data from nearly 4.5 million patients who were treated within [a] hospital chain over the last five years."

CaptainShuddup   Mon, 18 Aug 2014, 6:20am PDT   Share   Quote   Permalink   Like   Dislike (1)     Comment 40

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!

curious2   Sun, 15 Mar 2015, 1:45pm PDT   Share   Quote   Permalink   Like (1)   Dislike     Comment 41

Then there's ABIM and mandatory continuing medical "education":

"Videos and study sessions sold to help doctors prepare for re-certification exams often featured instructors saying physicians would never see a particular condition or use a certain diagnostic technique, but they needed to review it because it would be on the test. “Exam questions often are not relevant to physicians’ practice,” Teirstein says. “The questions are often out-dated. Most of the studying is done to learn the best answer for the test, which is very often not the current best practice.”
***
In January 2014, when the ABIM issued a series of new requirements for maintaining certification—that would have generated all new fees—Teirstein and his colleagues declared “enough.” They recently formed a new recertification organization called the “National Board of Physicians and Surgeons.”
***
The group’s fees are much, much lower than those charged by the ABIM. And its board and management—all top names in medicine—work for free."

In other words, the financial tsunami of Obamneycare has unleashed predictable waves of venality, but also a backlash (which the article calls a "civil war") in both the profession and the public at large. Instead of reforming health care, the legislation mandated its worst and most wasteful attributes, so now the last best hope of reform falls to unpaid volunteers.

sbh   Sun, 15 Mar 2015, 2:32pm PDT   Share   Quote   Permalink   Like (5)   Dislike (2)     Comment 42

curious2 says

In other words, the financial tsunami of Obamneycare has unleashed predictable waves of venality

Or, fully embraced the pre-existing venality and added to its marketablity through mandate. "Reform" was never a believable selling point.

CaptainShuddup says

even if you have cash, you can't get much desperately needed treatment without insurance.

Bullshit. If you're lazy enough you can find impediment anywhere. If you're a natural born victim you'll find your oppressor is as common as the rain. If you're both, as obviously you are, all you do is pout.

MMR   Sun, 15 Mar 2015, 3:43pm PDT   Share   Quote   Permalink   Like   Dislike     Comment 43

Ceffer says

paper mill

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

thunderlips11   Sun, 15 Mar 2015, 4:30pm PDT   Share   Quote   Permalink   Like (2)   Dislike     Comment 44

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.

curious2   Sun, 15 Mar 2015, 5:32pm PDT   Share   Quote   Permalink   Like (7)   Dislike (1)     Comment 45

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.

carrieon   Sun, 15 Mar 2015, 6:24pm PDT   Share   Quote   Permalink   Like   Dislike     Comment 46

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!

MMR   Sun, 15 Mar 2015, 8:41pm PDT   Share   Quote   Permalink   Like (1)   Dislike     Comment 47

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.

curious2   Mon, 18 May 2015, 4:28pm PDT   Share   Quote   Permalink   Like   Dislike     Comment 48

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

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