This article is loaded with info. Here is my breakdown:
1) No one went to jail. When hospitals commit Medicare fraud, they pay fines. When doctors are accused of doing this, they go to prison.
2) The HCA mouthpiece, Fishbough, blamed the doctors. I wouldn’t be very happy about this if I were one of the physicians performing these kyphoplasties (procedures that were making the mother ship lots of dough) only to be blamed for the backroom upcoding to get even more loot from Medicare (taxpayers). Another reason, I guess, hospitals like to hire physicians, is to maintain a stable of defenseless whipping boys.
3) It is interesting I think that billing this kyphoplasty procedure as an inpatient procedure produced significantly more revenue than the same procedure billed as an outpatient procedure. Keep in mind the hospital in all likelihood wasn’t billing for days the patients stayed in the hospital, just that this was “inpatient” instead of “outpatient.”
4)OU Medical Center, one of HCA’s many hospitals and home of the state’s only Level 1 trauma center, seemed to have enough dough to purchase the Edmond hospital recently. This is amazing to me that even after caring for all of the uninsured trauma patients they still managed to come up with enough money to purchase this suburban facility. They have obviously shifted their costs quite successfully to others (including the state legislature and taxpayers).
5) OU Medical Center will have no problem writing a $7.1 million dollar check to cover their fine. This will help one of their corporate divisions not make a profit, I suppose. Rather than whine and worry about how paying this fine will force this institution to curtail services in other areas, the spokesman was “pleased to see new clarification.”
We don’t do kyphoplasties at our facility because unlike the hospitals (who have successfully lobbied to bill for supplies, actually inclining them to embrace waste), we are not able to bill third parties for the incredibly expensive supply charges the vendors have attached to their spine fracture kits and glue. The vendors charge the hospitals ridiculous amounts because they know the hospitals don’t really care. Apparently not satisfied with this vendor-lust having shut out outpatient surgery centers as competitors for this procedure, hospitals all over the country have padded their wallets claiming the even higher reimbursement of “inpatient” instead of “outpatient.” This is a great example of how the presence of government in health care leads to fraud and explodes the costs of procedures. This article also reveals, I think, the lobbying success of the hospital Crips and Bloods who are happy to pay millions in headline-making fines while raking in billions from the sick and the taxpayers, all the while making the case for even more loot in the forms of Obamacare and its Medicaid expansion.
G. Keith Smith, M.D.