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U.S. Rep. Bill Pascrell (D-N.J.) talks with reporters during a meeting of the House Democratic Caucus in the Capitol on Tuesday, April 30, 2019. (Photo: Tom Williams/CQ Roll Call)

House Dem Demands Biden HHS Probe Hospital Behemoth for Bilking Medicare

"Workers, patients, and taxpayers need to know the truth about unnecessary charges and understaffing," said SEIU, welcoming Rep. Bill Pascrell's call to investigate HCA Healthcare.

Jessica Corbett

Congressman Bill Pascrell this week pushed for a federal probe of HCA Healthcare amid allegations of unnecessary admissions of Medicare patients and understaffing issues at the nation's biggest hospital system.

"Because of its mammoth size, HCA sets the pace for both for-profit and not-for-profit hospitals in the United States."

The New Jersey Democrat on Thursday revealed letters he sent Tuesday to Health and Human Services (HHS) Secretary Xavier Becerra—requesting an investigation of the chain's emergency admissions practices, including its joint venture with EmCare—and HCA CEO Samuel Hazen, requesting responses to a series of questions by September 27.

The letters contain similar language about accountability and allegations against HCA. Pascrell wrote to Becerra that "as HCA is the largest health system in America, transparency and oversight are essential to ensuring that hospitals, like those in HCA's system, are honest stewards of taxpayer dollars."

"Recent reports of systematic, unnecessary inpatient admissions intended to raise more-profitable reimbursement rates, in addition to severe understaffing issues, raise disturbing questions about HCA's corporate policies and practices," added the congressman, who chairs the House Ways and Means Committee's oversight panel.

The letter continues:

Because of its mammoth size, HCA sets the pace for both for-profit and not-for-profit hospitals in the United States. In 2021, HCA's profits were almost $7 billion, up nearly 100% in one year. This is welcome news for shareholders, since HCA repurchased $8.2 billion worth of its shares in 2021 and recently authorized an additional $8 billion of share repurchases3 all during the Covid-19 pandemic. Yet this single-minded focus on profits might be bad news for patients, families, workers, Americans taxpayers, and the Medicare program.

Press and investigative reporting have identified that patients in HCA's emergency departments may have been admitted for inpatient stays regardless of medical necessity. One recent report estimates that these unnecessary admissions by HCA may have charged $1.8 billion in excess amounts to the Medicare program from 2008 to 2019. I am especially alarmed by these findings given HCA's history of healthcare fraud settlements with both federal and state authorities.

Pascrell pointed to claims that HCA "sets corporate admission targets and routinely threatens retaliation against staff," which may be tied to its relationship with EmCare, a subsidiary of the private-equity-owned Envision Healthcare. 

The congressman also highlighted academic research under peer review about emergency admissions of Medicare patients—including findings that HCA Florida facilities admitted patients more than would be expected given their diagnoses.

The letters come after an activist group sponsored by major unions including the Service Employees International Union (SEIU) last year pressured HCA to investigate "long-standing and continually growing level of excess Medicare emergency department admissions" at its hospitals.

SEIU on Thursday thanked Pascrell for his efforts and said that "workers, patients, and taxpayers need to know the truth about unnecessary charges and understaffing."

HCA spokesperson Harlow Sumerford told Axios on Friday that the company is reviewing the letter and will respond to Pascrell's requests for information.

Sumerford noted that when these issues were raised by the union group, HCA filed a public response with the U.S. Securities and Exchange Commission, and said that "we believe that our operational processes and procedures are working well and that we are meeting the healthcare needs of our patients and communities."

Notably, U.S. Sen. Rick Scott (R-Fla.), a potential 2024 GOP presidential candidate, "was previously CEO of HCA during the time the FBI raided company facilities in 1997 to investigate fraud claims," Axios reported. "He was ousted before the company settled with the federal government."

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