Friday, July 26, 2013

HCA Faces False Claims Suit Over 'Fraudulent' Billing

By Dan Prochilo

 A whistleblower suit unsealed Friday alleges a Florida hospital owned by Hospital Corp. of America Holdings Inc. falsified records to dupe Medicare and Medicaid into covering unsafe, sometimes fatal, procedures that were ineligible for reimbursement because they violated federal rules.
Northside Hospital in St. Petersburg fraudulently claimed that procedures performed by
unsupervised medical interns and resident physicians had in fact been overseen by its
medical staff and submitted other bogus claims to illegitimately extract payment from federal
health care programs, the qui tam suit alleges.
"The lack of teaching physician supervision over medical students and residents has caused
a severe detrimental effect upon the quality of care received by patients at Northside
Hospital and certain avoidable injuries," according to the complaint, which was filed May 30
but wasn't unsealed until Friday.
Rife with horrific anecdotes about patients who lost limbs and died allegedly as a result of
improper medical care, the suit was brought by Brenda Farnsworth, the vice president of
Quality and Risk Management for the hospital since August 2011.
Farnsworth, who has been on forced administrative leave since February 2012, accused
Northside Hospital, HCA subsidiary Parallon Business Solutions LLC and Nashville-based HCA
— which runs 162 hospitals and 113 surgery centers in the U.S. and U.K. — of violating the
federal False Claims Act.
The suit said the bogus claims the hospital sent to the federal government for some its
medical procedures masked that they had been performed belatedly and unsafely. Had the
incidents been accurately reported, they would never have been covered by Medicare and
Medicaid, which provide benefits to about 50 percent of the hospital's patients, the
complaint said.
Among the noncompensable claims that the hospital made was a bill for the treatment of a
44-year-old patient admitted in late May 2011 from the Pinellas County Jail with
gastrointestinal bleeding, the suit said. Despite vomiting a liter and a half of blood, the
patient was not seen by a doctor for nearly four hours, when an unsupervised resident
responded to an emergency call from nurses, the suit said.
The patient died with no teaching physician present, yet the hospital fraudulently billed
Medicaid as if two doctors had been supervising the resident’s vain resuscitation efforts, the
suit said.
In one November 2011 case, an unsupervised resident allegedly ignored a doctor's order to remove a catheter line that been inserted directly into the bone marrow of a 27-year-old woman, leaving it there for five hours longer than it should have been.
The patient "lost a large portion of her leg and was hospitalized for over two months," the
suit said. Once again, the hospital falsely claimed in its bills to Medicare that a supervising
doctor had been present for procedures handled by the resident.
Florida law requires that adverse incidents in a hospital be reported to the state Agency for
Health Care Administration within 15 days, but Farnsworth said she was reprimanded by her
employer for reporting the mishap, the suit said.
Farnsworth additionally alleged that Northside personnel forced or advised patients to go to
other facilities once their federal benefits were depleted, then falsely indicated in their
medical records that they had left against medical advice so the hospital still could bill the
government for the services it had provided.
The hospital allegedly permitted suspended doctors to perform procedures on patients and
put down the names of physicians who still had medical privileges on the claims submitted to
Medicare and Medicaid, "even though these services were ineligible for ... reimbursement
without a valid physician's order," according to the suit.
Farnsworth also said the hospital's farming out of its medical record department to a
subsidiary of HCA in early 2010 and later, to Parallon, violated rules of the Centers for
Medicare and Medicaid Services requiring medical record personnel to be hospital employees.
Farnsworth said she was abruptly placed on administrative leave and escorted from the
hospital days after submitting a complaint to HCA that Northside Hospital was violating
"several laws, rules and regulations" and for reporting medical-record deficiencies to
government officials.
According to the suit, the pretext for the penalty was "insubordination," but "the real reason
... was because she had direct knowledge of various types of fraudulent conduct occurring
at Northside Hospital and the defendants did not want her to cooperate in [an] upcoming
CMS survey," the suit said.
Representatives for HCA and Northside Hospital could not be immediately reached for
comment Friday.
Farnsworth is represented by J. Meredith Wester, Richard Candelora, and Krista Pendino of
Mechanik Nuccio Hearne & Wester, P.A.
Counsel information for HCA and the other defendants was unavailable.

The case is United States of America et al v. Hospital Corporation of America et al, case
number 8:12-cv-00734 before the U.S. District Court for the Middle District of Florida.

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