The Feds Join Lawsuits in “Big Medicine” Alleged Scheme

by Staff | February 19th, 2014

The U.S. Justice Department has joined in several separate whistleblower lawsuits against Health Management Associates, a for profit hospital chain based in Naples, Florida.  According to the New York Times, it is alleged that HMA had an internal strategy to increase admissions to its hospitals regardless of whether the medical treatment was necessary and scored physicians by how close they came to meeting predetermined targets, including admitting at least 50% of those patients over 65 who came into the emergency room.  These target numbers resulted in clinically inappropriate treatment and unnecessary tests. The lawsuits describe a pattern of financial incentives and threats to inflate Medicare and Medicaid payments by admitting patients for things like a fever, when the patient’s temperature was 98.7, a reading only slightly above normal.  HMA has just agreed to purchase another hospital chain which will make HMA the nation’s second largest  for profit hospital chain, with more than 200 facilities.  Such allegations are not uncommon.  The Federal Government is looking into questionable admissions and billings at many hospitals, including HCA, the country’s largest.  It appears as if corporate interests are affecting decision making by doctors.  Critics of this emerging system of corporations owning hundreds of hospitals and purchasing private practice groups, claim that doctors who fail to meet targeted goals set by the corporation are punished while others who meet the corporate goals get rewarded, and as a result patient care is compromised and costs continue to explode.

Authored by: Personal Injury and Trial Attorney Ellen McCarthy