Report Questions Necessity of Heart Procedures Performed at HCA Hospitals

The largest hospital chain in the U.S., HCA Holdings, Inc., has come under scrutiny for the way some heart surgeries were conducted at many of its hospitals, mostly in Florida.  According to various media reports, HCA has confirmed the U.S. attorney in Miami has requested information on reviews conducted at some HCA facilities that assessed the medical necessity of certain interventional heart procedures, including stenting and angioplasties.

Yesterday, The New York Times reported that HCA had investigated numerous cases at its hospitals involving unnecessary and potentially dangerous heart surgeries in its facilities.  According to the Times, HCA didn’t contact patients, medical authorities or insurers about the results of those investigations.  

According to a report from the Associated Press, HCA runs 63 hospitals and 110 free-standing surgery centers throughout the U.S.  HCA says reviews of the type highlighted by the Times article were conducted at about 10 of its facilities, most in Florida.  A third party organization was retained to conduct the reviews.

According to the Times, the hospital reviews uncovered evidence that as far “back as 2002 and as recently as late 2010 showing that some cardiologists at several of its hospitals in Florida were unable to justify many of the procedures.”  Hospitals cited by the Times included Cedars Medical Center in Miami, which the company no longer owns, and the Regional Medical Center Bayonet.

The Times investigation was based on a review of internal emails, confidential memos and transcripts from hearings that raised questions about whether heart procedures were being done unnecessarily at HCA hospitals, as well as interviews with doctors. The Times was unable to ascertain how many unneeded procedures there were or how many patients might have died or been injured as a result.  But the report maintained that “the documents suggest that the problems at HCA went beyond a rogue doctor or two.”

Internal communications reviewed by the Times indicated that rather than asking whether patients had been harmed or whether regulators needed to be contacted, hospital officials asked for information on how the physicians’ activities affected the hospitals’ bottom line.  But HCA insisted to the Times that decisions made at its hospitals weren’t motivated by financial concerns, but instead “demonstrate the strong focus we have on quality patient care.

Just prior to the publication of the Times article, HCA took the unusual step of posting a rebuttal to the points raised by the report on its website.  According to the Associated Press, the letter notes that the necessity of some heart procedures is “the subject of much debate in the cardiology community.”

In a filing with the U.S. Securities and Exchange Commission yesterday, HCA also disclosed that the U.S. Department of Justice is reviewing whether charges to the federal government related to use of implantable cardio-defibrillators (ICDs) met with billing criteria set by Medicare, Reuters said.  The review will scrutinize ICD billing and medical records at 95 of the company’s 163 hospitals from October 2003 to the present.

Between 2000 and 2003, HCA paid a total of $1.7 billion in civil penalties and criminal fines to settle a massive federal investigation into fraudulent billing practices, according to Reuters.

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