Hospital chain performed unnecessary cardiac work to boost profits

by Charles Miller

According to a recent New York Times article, doctors at hospital giant HCA performed numerous costly, risky and unnecessary cardiac procedures. Concerns were first raised in the summer of 2010 by a former nurse at the Lawnwood Regional Medical Center in Fort Pierce, Florida. According to the nurse, one of the doctors at Lawnwood had been performing unnecessary and risky heart procedures on patients. An internal investigation by HCA confirmed the problem, finding that many unnecessary procedures had been performed in the hospital’s “cath lab.”

But the problem was much deeper than first thought. HCA, the largest for-profit hospital chain in the United States with 163 facilities in about 20 states, uncovered evidence showing that cardiologists at several of its hospitals were unable to justify many of the procedures they were performing. According to internal reports, in some cases, the doctors made misleading statements in medical records that made it appear the procedures were necessary, according to internal reports. The problems dated back to as early as 2002.

At Lawnwood, where an invasive diagnostic test known as a cardiac catheterization is performed, about half the procedures, or 1,200, were determined to have been done on patients without significant heart disease, according to a confidential 2010 review. At Bayonet Point, another HCA facility, a 44-year-old man complaining of chest pain suffered a punctured blood vessel and a near-fatal irregular heartbeat after a doctor performed an unnecessary procedure. In another incident, a woman with no significant heart disease went into cardiac arrest after a vessel was cut when a Bayonet Point cardiologist inserted a stent, a mesh-like device that opens coronary arteries.

HCA revealed this week that the civil division of the United States attorney’s office in Miami recently requested information on reviews assessing the medical necessity of interventional cardiology services provided at 10 of HCA’s hospitals. This would not be the first run-in with federal authorities for the hospital giant. In 2000, HCA reached a $1.7 billion settlement with the Justice Department relating to a huge Medicare fraud case involving overbilling.

Two years after the 2000 fraud settlement, company executives uncovered problems in the cardiac catheterization lab at Cedars Medical Center, according to accounts that became public. An outside consulting group hired by HCA provided a report that raised “questions regarding the medical necessity of some of the procedures,” the company said in a news release in early 2003. Soon after the Cedars episode, HCA executives noticed that the hospital in Hudson, Florida, the 290-bed Regional Medical Center Bayonet Point, was implanting an unusually high number of cardiac stents, given the size of the population.

In 2003, HCA dispatched a group that oversees its hospitals’ cardiac care to investigate. In a confidential memo, the team found several instances where stents had been placed in patients did not have significant blockage. HCA later brought in an external company to examine medical records from Bayonet Point.

In a confidential memo prepared in December 2004 and reviewed by the New York Times, that company concluded that as many as 43% of 355 angioplasty cases, where doctors performed invasive procedures to open up a patient’s arteries, were outside reasonable and expected medical practice. Worse, the investigation revealed that some physicians had indicated in medical records that the patients had blockages of 80-90% when a later, more scientific analysis of a sampling of cases revealed the blockages had ranged from 33-53%. After receiving the report, Bayonet Point suspended the privileges of nine physicians but withheld the results of its investigation from the media, the public and the government.

The reason for the secrecy was obvious: cardiology is a lucrative business for HCA, and the profits from testing and performing heart surgeries played a critical role in the company’s bottom line in recent years. In fact, some of HCA’s busiest Florida hospitals perform thousands of stent procedures each year. Medicare reimburses hospitals about $10,000 for a cardiac stent and about $3,000 for a diagnostic catheterization. HCA has more than 100 catheterization labs across the country and the one at Lawnwood was a financial juggernaut. It accounted for 35 percent of the hospital’s net profits, according to financial documents.

If you or a loved has undergone an unnecessary medical procedure, or received substandard care from a doctor or hospital, you may be entitled to compensation. To find out if you may have a case, contact the lawyers at Heygood, Orr & Pearson by calling toll-free at 1-877-446-9001, or by filling out our free case evaluation form.