The Frist family, founders and biggest shareholders of HCA (NYSE:HCA), was named healthcare’s top Pandemic Profiteer by the Institute for Policy Studies this month after their wealth more than doubled to $15.6 billion in the pandemic.
Potentially Excessive Emergency Department Admissions
HCA Healthcare appears to admit far more Medicare patients who visit its emergency rooms than would be expected based on their patient population. According to a Modern Healthcare article, this practice may have netted HCA excess Medicare payments of $1.1 billion over the past five years and $1.6 billion since 2009.
This analysis suggests that patients may be admitted as inpatients to hospitals when they might more appropriately be treated in an outpatient setting. This would generate higher bills, and higher profits for HCA.
According to Change to Win Investment Group's analysis, the issue appears to be concentrated in Texas and Florida. HCA Texas and Florida hospitals accounted for at least 70% of outlier hospitals – those above the 80th percentile with respect to emergency department admissions – in the HCA system nationally.
The $1.6 billion in excess Medicare payments should be of immediate concern to all taxpayers and Medicare beneficiaries across the country.
MedPage Today quotes the investors, "’Plainly, this level of excess payment is sufficiently large that it creates a material risk of regulatory enforcement actions as well as private litigation’” and notes that this is because “federal regulators consider how inappropriate billing practices affect public payers, and in the private sector, insurers would go through private litigation to seek remedy for excessive bills.”