New Jersey Legislator Requests Federal Investigation Of Nashville Healthcare Company

Image Credit: hcahealthcaretoday.com

The Tennessee Conservative [By Jason Vaughn] –

HCA Healthcare Inc. based out of Nashville could soon find itself the focus of a federal investigation. 

Chair of the U.S. House of Representatives’ Ways and Means oversight subcommittee, Rep. Bill Pascrell of New Jersey, sent a letter last week requesting that the U.S. Department of Health and Human Services open an investigation into “alleged fraud and staffing issues” at facilities run by HCA.

The letter was written to Health and Human Services Secretary Xavier Becerra. In the document, Pascrell focuses primarily on accusations made by the Services Employees International Union. The Union claims that HCA emergency departments regularly admit patients for inpatient stays, even if they do not have a legitimate medical need. Nearly $1.8 billion in excess Medicare payments may have been received from this alleged practice since 2008, according to a January report released by the union. 

A letter was also sent by Pascrell to HCA CEO Sam Hazen asking for company information regarding physician incentives and performance, staffing levels, and the company’s internal audit process for Medicare billing. 

HCA told the Nashville Business Journal that it is currently working to provide that information to members of the House Ways and Means Committee’s subcommittee on oversight, according to their emailed statement. 

“The letter from Congressman Bill Pascrell repeats claims made by SEIU and its affiliates (CTW and SOC) over the past few years about emergency department admissions rates. We categorically reject any allegation that physicians admit patients to our hospitals on the basis of anything other than their independent medical judgment and their patients’ individual conditions and medical needs. There are no HCA Healthcare policies, processes or practices that require physicians to admit patients to our hospitals. 

We are reviewing the letter from Subcommittee Chairman Pascrell and will respond, but the allegations made by the SEIU to the Congressman are based upon an invented and false premise and a lazy and manipulative argument. The SEIU has engineered a metric (the “standard” or “average” rate for emergency department admissions) that exists for no other purpose than the public criticism of HCA Healthcare.  It appears that the SEIU used publicly available Medicare claims data and simple math to divide the number of ED admissions by the number of ED visits and arbitrarily deemed the resulting number to be a valid metric or benchmark.  

That metric is, however, not recognized by healthcare providers, experts or academics, and the failure of any hospital, including those operated by HCA Healthcare, to meet that metric is utterly meaningless. Credible and knowledgeable healthcare experts understand that many variables, including community demographics, hospital services, patient needs and acuity, and other related factors need to be considered in any analysis of hospital emergency departments. 

That said, even assuming, without agreeing, that the SEIU metric is meaningful, HCA Healthcare hospitals are in line with some of the best in the nation. Using the SEIU’s own methodology for example, of the top 20 US News’ Best Hospitals in 2021, the highest emergency department admission rate was 61% and the lowest was 28%. Comparatively, HCA Healthcare’s national average is on the lower end of that range at 37%.

It seems the information the SEIU presented to Subcommittee Chairman Pascrell was incomplete and intentionally misleading.” 

With nearly 11,000 local employees and $58.75 billion of revenue in 2021, HCA (NYSE: HCA) is Middle Tennessee’s largest publicly traded company, according to Nashville Business Journal research. There are 182 hospitals across 20 states and the United Kingdom all run by this company, more than any for-profit hospital operator in the United States.

As nursing unions have recently made a number of allegations against various companies, the investigation of HCA being accused of understaffing hospitals, unnecessarily admitting patients and forcing staff to reuse personal protective equipment is the most recent and one of the largest.

In the letter to HHS, Pascrell also notes allegations that HCA sets corporate patient admission goals and then issues threats of penalties if staff members do not reach those set targets. The letter states that EmCare, a physician staffing firm that provides staffing at many HCA hospitals, may have an integral role in the setting and implementation of those goals.

“Improper hospital admissions can have cascading effects on patients and workers. Unnecessary admissions expose patients to unnecessary treatments. This creates an added potential risk of complications and the possibility of new infections for patients. Improper admissions also put additional burdens on hospital workers who are often already overstretched – especially in HCA hospitals, given that HCA’s average staffing levels trail the national averages by 30 percent. There are numerous documented situations involving concerns about quality issues in HCA-owned hospitals associated with low staffing levels, including preventable patient deaths, infection control breakdowns, and at least one hospital being threatened with termination from the Medicare program,” Pascrell writes in the letter to Becerra. “In light of reports that there may be misconduct and potentially the improper shifting of taxpayer dollars, I ask that HHS launch an investigation into the allegations leveled against HCA regarding its emergency department admissions practice, including its joint venture with EmCare.”

If DHS determines that an investigation is warranted, it would not be the first time the federal government has looked into HCA in regards to Medicare payments. In 1997, agents from the FBI, IRS, the Department of Health and Health and Human Services raided Columbia/HCA’s operations in El Paso, Texas, after a U.S. Senate subcommittee alleged that it had evidence of improper Medicare claims. The FBI raided HCA operations across six states as a result of the claims against the company. 

A $1.7 billion settlement was eventually reached between HCA and the government to find a resolution for what was, at the time, the biggest case of health care fraud in U.S. history. 

About the Author: Jason Vaughn, Media Coordinator for The Tennessee Conservative  ~ Jason previously worked for a legacy publishing company based in Crossville, TN in a variety of roles through his career.  Most recently, he served as Deputy Director for their flagship publication. Prior, he was a freelance journalist writing articles that appeared in the Herald Citizen, the Crossville Chronicle and The Oracle among others.  He graduated from Tennessee Technological University with a Bachelor’s in English-Journalism, with minors in Broadcast Journalism and History.  Contact Jason at news@TennesseeConservativeNews.com