HCA Inc. (nonfiction)
HCA Inc.
Justice Department settlement
JUNE 26, 2003
LARGEST HEALTH CARE FRAUD CASE IN U.S. HISTORY SETTLED HCA INVESTIGATION NETS RECORD TOTAL OF $1.7 BILLION
WASHINGTON, D.C. - HCA Inc. (formerly known as Columbia/HCA and HCA - The Healthcare Company) has agreed to pay the United States $631 million in civil penalties and damages arising from false claims the government alleged it submitted to Medicare and other federal health programs, the Justice Department announced today.
This settlement marks the conclusion of the most comprehensive health care fraud investigation ever undertaken by the Justice Department, working with the Departments of Health and Human Services and Defense, the Office of Personnel Management and the states. The settlement announced today resolves HCA's civil liability for false claims resulting from a variety of allegedly unlawful practices, including cost report fraud and the payment of kickbacks to physicians.
Previously, on December 14, 2000, HCA subsidiaries pled guilty to substantial criminal conduct and paid more than $840 million in criminal fines, civil restitution and penalties. Combined with today's separate administrative settlement with the Centers for Medicare & Medicaid Services (CMS), under which HCA will pay an additional $250 million to resolve overpayment claims arising from certain of its cost reporting practices, the government will have recovered $1.7 billion from HCA, by far the largest recovery ever reached by the government in a health care fraud investigation.
"Health care providers and professionals hold a public trust, and when that trust is violated by fraud and abuse of program funds, and by the payment of kickbacks to the physicians on whom patients and the programs rely for uncompromised medical judgment, health care for all Americans suffers," Robert D. McCallum, Jr., Assistant Attorney General for the Civil Division said. "This settlement brings to a close the largest multi-agency investigation of a health care provider that the United States government has ever undertaken and demonstrates the Department of Justice's ongoing resolve and commitment to pursue all types of fraud on American taxpayers, and health care program beneficiaries."
"Let this case be a continuing reminder to all that in the fight against health care fraud this office will not be deterred," said Acting Principal Deputy Inspector General Dara Corrigan. “Medicare dollars paid to provide ever more expensive health care services to the country's taxpayers should never be fraudulently diverted. This is our job and our trust and we take these duties very seriously," Corrigan concluded.
This latest settlement resolves fraud allegations against HCA and HCA hospitals in nine False Claims Act qui tam or whistleblower lawsuits pending in federal court in the District of Columbia. Under the federal False Claims Act, private individuals may file suit on behalf of the United States and, if the case is successful, may recover a share of the proceeds for their efforts. Under the settlement, the whistleblowers will receive a combined share of $151,591,500, the highest combined qui tam award ever paid out by the government.
"We are grateful for the assistance given by the whistleblowers over the course of the past nine years of investigation and litigation,” McCallum said. “And we are proud of the work of government personnel as well as counsel for the whistleblowers, who together pursued these matters through investigation and strenuous litigation. This result demonstrates the commitment of the Department to the qui tam statute and that the statute works as Congress intended."
Under the first of three agreements announced today, which becomes effective upon the court's dismissal of the lawsuits, HCA will pay nearly $620 million to resolve eight whistleblower lawsuits in which the government had intervened alleging that HCA systematically defrauded Medicare, Medicaid and other federally funded health care programs through schemes dating back to the late 1980s. HCA will pay an additional $11 million to resolve separate allegations of improper HCA billing practices.
The settlement requires HCA to pay:
$356 million to resolve whistleblower lawsuits alleging that HCA engaged in a series of schemes to defraud Medicare, Medicaid and TRICARE, the military’s health care program, through hospital cost reports, the year end claims submitted by hospitals to the government to reconcile payments received throughout the year with amounts they claim are actually owed. In 2001, a subsidiary of Nashville-based HCA, Columbia Management Companies, Inc., pled guilty in the Middle District of Florida to related charges on eight counts of making false statements to the United States and paid $22.6 million in criminal fines. An additional amount of $20 million of the settlement is being paid toward a resolution of cost reporting fraud allegations pursued separately by James Alderson and John Schilling, the relators who filed the lawsuits. In total, the two relators are to receive a total of $100 million as their statutory share of the settlement.
$225.5 million to resolve lawsuits alleging that HCA hospitals and home health agencies unlawfully billed Medicare, Medicaid and TRICARE for claims generated by the payment of kickbacks and other illegal remuneration to physicians in exchange for referral of patients. In 2001, Columbia Management Companies, Inc., pled guilty to one count of conspiracy to pay kickbacks and other monetary benefits to doctors in violation of the Medicare Antikickback Statute and paid a $30 million criminal fine. Dr. James Thompson, a doctor who filed suit against the company in 1995, will receive $41.5 million as his statutory share of the settlement. Gary King, a former HCA employee, will receive $5 million and Ann Mroz, a former HCA nurse, will receive a share of $837,500.
$17 million to resolve allegations that certain company-owned hospitals billed Medicare for unallowable costs incurred by a contractor that operated HCA wound care centers, and for a non-covered drug that the contractor manufactured and sold to hospital patients. The 2001 Columbia Management Companies' guilty plea concerning cost report fraud included a charge related to wound care center costs. HCA's wound care center management contractor, Curative Healthcare Services, Inc., previously paid $16.5 million to resolve related allegations pending at one time in these same lawsuits. Joseph "Mickey" Parslow, a former HCA financial officer, will receive $2,990,000 and Francesco Lanni, a former Reimbursement Manager at the Wound Care Center at New York Methodist Hospital in Brooklyn, New York, will receive a share of $680,000.
$5 million to resolve allegations concerning the transfer of patients from HCA facilities to other facilities and the claiming of excessive costs for those transfers.
$5 million to resolve allegations that HCA's Lawnwood Regional Medical Center in Fort Pierce, Florida submitted false claims in Medicare cost reports by inflating its entitlement to funds to treat indigent patients and by shifting employee salary costs in order to increase its reimbursement from the federal health care program. $950,000 to settle allegations made by Michael Marine that HCA improperly shifted its home office costs to hospitals. Marine will receive a share of $116,500.
Today's settlement agreement incorporates the terms of a Corporate Integrity Agreement executed by HCA and the Office of the Inspector General, Department of Health and Human Services in December 2000 that obligated the company to engage in significant and comprehensive compliance efforts into 2009.
In a separate agreement, HCA agreed to pay $1.5 million to resolve allegations that an Atlanta, Georgia hospital, West Paces Medical Center, paid kickbacks for the referral of diabetes patients. Those allegations had been pursued since 1996 by a whistleblower in a case in which the United States had declined to intervene, captioned U.S. ex rel. Pogue v. American Healthcorp, Inc. et al.. Pogue, a former employee of a co-defendant in the case, Diabetes Treatment Centers of America, will receive a share of $405,000 from the HCA settlement. Pogue continues to litigate claims against his former employer and a group of Atlanta physicians.
Additionally, a state negotiating team appointed by the National Association of Medicaid Fraud Control Units has reached agreement with HCA to resolve related issues with affected state Medicaid plans for $17.5 million, representing direct state losses. The terms of that agreement are being finalized by the parties and are not part of today's settlement.
Today's administrative agreement between HCA and CMS will require HCA to pay CMS $250 million in order to resolve claims they maintained against each other arising from HCA's hospital cost reports and home office cost statements for cost reporting periods ending July 31, 2001. These claims resulted from HCA cost reports that were not processed since 1997 as a result of the government's investigation.
Politifact article
By Amy Sherman - March 3, 2014 - Summary: "Mostly true"
Rick Scott 'oversaw the largest Medicare fraud' in U.S. history, Florida Democratic Party says
First, Gov. Rick Scott scared the bejesus out of seniors with an online ad claiming that Medicare rate cuts would lead them to lose access to their doctors, hospitals and preventive care.
Then, the Florida Democratic Party fired back at Scott, issuing a press release that called Scott "the ultimate Medicare thief."
The Democrats were referring to Scott’s prior tenure as CEO of Columbia/HCA about a decade ago, when the hospital company was fined $1.7 billion for Medicare fraud.
"Rick Scott is saying Democrats are committing Medicare robbery, when in fact he's the ultimate Medicare thief. He lost the right to accuse Democrats of raiding Medicare when he oversaw the largest Medicare fraud in the nation's history. Rick Scott's company stole money that should have gone to health care for seniors," said Florida Democratic Party spokesman Joshua Karp in the Feb. 25 press release.
Separately, we have fact-checked Scott’s claim "we are seeing dramatic rate cuts" to Medicare that will affect people's choice of doctor, hospital and preventive care. We concluded that Scott had failed to say that the rate cut only applies to Medicare Advantage, and thus only affects a fraction of all Medicare beneficiaries. Also, it could be several months before we know the actual impact of the cut which could vary county by county. We rated Scott's claim Mostly False.
Here, we’ll fact-check the Democratic counter-attack that Scott "oversaw the largest Medicare fraud in the nation’s history."
Scott’s tenure at Columbia/HCA
During Scott’s 2010 race for governor, PolitiFact fact-checked multiple claims related to his tenure at Columbia/HCA. Now, we’ll recap some of our earlier discussion of the investigation and fine.
Scott started what was first Columbia in 1987, purchasing two El Paso, Texas, hospitals. Over the next decade he would add hundreds of hospitals, surgery centers and home health locations. In 1994, Scott’s Columbia purchased Tennessee-headquartered HCA and its 100 hospitals, and merged the companies.
In 1997, federal agents went public with an investigation into the company, first seizing records from four El Paso-area hospitals and then expanding across the country. The investigation focused on whether Columbia/HCA had committed Medicare and Medicaid fraud.
Scott resigned as CEO in July 1997, less than four months after the inquiry became public. Company executives said had Scott remained CEO, the entire chain could have been in jeopardy.
During his 2010 race, the Miami Herald reported that Scott had said he would have immediately stopped his company from committing fraud -- if only "somebody told me something was wrong." But there were such warnings in the company’s annual public reports to stockholders -- which Scott had to sign as president and CEO.
Scott wanted to fight the accusations, but the corporate board of the publicly traded company wanted to settle.
In December 2000, the U.S. Justice Department announced that Columbia/HCA agreed to pay $840 million in criminal fines, civil damages and penalties.
Among the revelations from the 2000 settlement:
• Columbia billed Medicare, Medicaid, and other federal programs for tests that were not necessary or had not been ordered by physicians;
• The company attached false diagnosis codes to patient records to increase reimbursement to the hospitals;
• The company illegally claimed non-reimbursable marketing and advertising costs as community education;
• Columbia billed the government for home health care visits for patients who did not qualify to receive them.
The government settled a second series of similar claims with Columbia/HCA in 2002 for an additional $881 million. The total for the two fines was $1.7 billion.
On Scott’s 2010 campaign website, he admitted to the $1.7 billion fine, though the link is no longer on the site.
What type of record was that fine?
The fine clearly set a record, though the Justice Department (and media reports at the time) were not always consistent in their terminology, sometimes describing it as the "largest government fraud settlement in U.S. History" and other times more specifically as the "largest health care fraud case in U.S. History."
A Justice Department spokeswoman said that officials refer to Columbia/HCA as "largest health care fraud" rather than the more narrow term "Medicare fraud" because it involved defrauding other government programs such as Medicaid rather than Medicare exclusively. The Justice Department described in detail the various ways the company defrauded Medicare and other government health programs here.
Here’s a key point, though: While the Columbia/HCA settlement was a record at the time for health care fraud, it has since been surpassed. In cases related to the improper promotion of certain drugs, Johnson & Johnson agreed to a a $2.2 billion settlement in 2013, Pfizer settled for $2.3 billion in 2009, and GlaxoSmithKline settled for $3 billion in 2012.
"HCA was the record health care fraud at the time. It’s now Glaxo," Justice Department spokeswoman Linda Mansour told PolitiFact in an email.
That said, these cases were a little different. While the Justice Department’s case against Columbia/HCA repeatedly mentions overbilling and defrauding Medicare and Medicaid specifically, the three newer cases focused on the marketing of drugs, with Medicare, Medicaid and other federal programs caught up in the impropriety, rather than being the specific targets of the fraud.
Because the Justice Department press releases explaining the settlements don’t explicitly break down how much of the misconduct in those more recent cases defrauded Medicare explicitly, it’s difficult to make comparisons.
The Pfizer case includes violations relating to misbranding and kickbacks, "so there may be a distinction to be made for that reason when thinking about whether it all should be classified under the very general category of ‘Medicare fraud,’ " said Asha Scielzo, who practices health care law at the firm Pillsbury Winthrop Shaw Pittman.
The Columbia/HCA case "still is the largest fraud settlement for a hospital corporation in U.S. history," since all the others involved pharmaceutical firms, added Zack Buck, a health care law professor at Mercer. "So I guess, the quote (by the Florida Democratic Party) is a little loose."
The Scott campaign did not respond to an inquiry for this fact-check. However in 2010, Scott told the Tampa Bay Times, "There's no question that mistakes were made and as CEO, I have to accept responsibility for those mistakes. I was focused on lowering costs and making the hospitals more efficient. I could have had more internal and external controls. I learned hard lessons, and I've taken that lesson and it's helped me become a better business person and a better leader."
Our ruling
The Florida Democratic Party said Scott "oversaw the largest Medicare fraud in the nation’s history."
The Columbia/HCA settlement has since been surpassed in dollar value, though the bigger cases involved Medicare somewhat less directly. Because the Democratic Party could have been a bit more specific in its wording -- by saying that Scott oversaw the largest Medicare fraud at the time -- we rate the claim Mostly True.
- [https://www.justice.gov/archive/opa/pr/2003/June/03_civ_386.htm LARGEST HEALTH CARE FRAUD CASE IN U.S. HISTORY SETTLED
HCA INVESTIGATION NETS RECORD TOTAL OF $1.7 BILLION] @ justice.gov