HMA | '60 Minutes' Allegations of quotas, fraud denied by boss

HMA's corporate offices in Naples, Fla.

HMA's corporate offices in Naples, Fla.

A Naples-based hospital operator landed on "60 Minutes" on Sunday, with the lead segment focused on accusations by more than 100 of its current and former employees that it has pressured its doctors to admit patients "regardless of medical need" to boost company profits.

The CBS investigation for the report on Health Management Associates Inc. — which owns 70 hospitals in 15 states — started more than a year ago. In Collier County, HMA's hospitals include Physicians Regional — Pine Ridge and Physicians Regional — Collier. Neither of the local hospitals was mentioned in the broadcast.

On camera, several of the company's former employees shared the same story, saying there were admission targets and software that coerced HMA doctors into admitting more patients. They accused the company of fraud and said doctors who didn't meet quotas faced threats they would be fired.

Alan Levine, an HMA senior vice president and Florida Group president, defended the company, saying allegations that the company put people in the hospital that shouldn't have been there were "absolutely wrong."

"HMA doesn't set quotas for hospital admissions," he told Steve Kroft, a CBS correspondent who investigated the segment.

After the broadcast, Levine told the Daily News nobody in the program questioned the quality of care that HMA hospitals provide. He pointed out HMA hospitals are recognized as best performers by Fortune magazine and other organizations.

"We measure everything we do, particularly in the emergency room where it is the highest-risk patients," Levine said Sunday night. "The one thing patients expect from us is they have the right care in the right setting at the right time. They did not once refute the data that we put out there.

"No one has pointed out that a patient has been admitted who should not have been."

In the "60 Minutes" segment, Kroft showed Levine a physician performance review from an HMA hospital in Durant, Okla., that included an admission goal of 20 percent.

Levine said he had never seen such a document.

"That's not from our company," he told Kroft. "I don't know where that came from."

Levine said the "admissions goal at any hospital is driven only by what the normal trend is for that hospital."

"If we had an admission goal of 20 percent, why is our admission (rate) 13 percent?" Levine told the Daily News after the broadcast.

"The data does not support the allegations they made."

Cliff Cloonan, the former assistant emergency room director at the Carlisle Regional Medical Center, an HMA hospital in Pennsylvania, and Scott Rankin, another doctor who worked for the same department, said they were told they would "lose their jobs" if they didn't start admitting more patients.

"My department chief said, we will admit 20 percent of our patients or somebody's going to get fired," Cloonan said. "There's no way you can do that and not have it be fraudulent because you're not admitting on the basis of medical requirements, you're basing it — it on — strictly an arbitrary number that has been pulled out."

For patients who were 65 and over, Rankin said the admission goal was 50 percent. Those would be Medicare patients, he said.

Kroft said the stories told by the former HMA employees on camera were echoed by thousands of documents that were examined for the investigative report, including emails.

One email shared with Levine said in all capital letters, "Only 14 admits so far!!!!!!! Act accordingly..." This email went to a new emergency room doctor at an HMA hospital in South Carolina: "We are under constant scrutiny... I will be blunt, I have been told to replace you if your numbers do not improve."

The former employees who appeared on camera agreed money was the chief motivator for the policies that were pushed to admit more patients. Rankin called it a "well thought-out plan," saying the control over emergency physicians came, in part, from corporate-wide computer software called Pro-Med, which was installed in every emergency room and automatically ordered up a battery of tests before patients were even seen by their treating physicians. HMA no longer uses the software.

Paul Meyer, who raised the issue of inappropriate admissions a few years ago while still working as the company's director of compliance, also talked to Kroft. Meyer was a 30-year veteran of the FBI, who supervised Medicare fraud in Miami before joining HMA. He alleges HMA intentionally billed Medicare and Medicaid for unnecessary hospital stays, to the tune of hundreds of thousands of dollars. He's now suing HMA for wrongful termination.

In response to Meyer's statement, Levine said his "assertions were not accurate" and he provided "incomplete information in the court of doing his own investigations."

HMA is being investigated by the U.S. Justice Department, which is looking into the management of its emergency room operations and the computer software Pro-Med.

John Schilling, a Naples resident who was a reimbursement supervisor at Columbia/HCA in Southwest Florida and later became a key whistle-blower in Columbia's fraud case in the 1990s, said for-profit systems such as HMA are in the business to make money.

When asked if other hospitals admit patients who might not need to be, Schilling said it happens.

"There is an industry trend of that happening," he said. "The way for them to make money, even a not-for-profit system, they need the patients, they need the admissions, they need to perform tests."

Staff writer Liz Freeman contributed to this story.

© 2012 marconews.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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