Congressional leader requests an investigation into HCA’s hospital admission practices

Nashville-based HCA, the nation’s largest private health system, has faced years of scrutiny from a powerful labor union over how it runs its emergency departments. And now Rep. Bill Pascrell, a Democrat from New Jersey, is calling for a federal investigation and asking questions of his own.

Pascrell chairs the House Ways and Means oversight subcommittee and has asked the U.S. Department of Health and Human Services, which oversees Medicare, to look into claims made in a report released released in 2020 by the SEIU national labor union.

“In light of reports that there may be misconduct and potentially the improper shifting of taxpayer dollars, I ask that HHS launch an investigation into the allegations leveled against HCA regarding its emergency department admissions practice,” Pascrell wrote in his letter.

Compared to non-HCA hospitals, the 58-page SEIU investigative report found HCA is much quicker to admit patients from the emergency department, estimating the unnecessary admissions resulted in overcharging the Medicare program $1.8 billion over roughly a decade.

The U.S. Justice Department has pursued such claims before. A civil and criminal investigation into HMA, acquired by Franklin-based Community Health Systems in 2014, resulted in a $262 million settlement in 2018. The government alleged that HMA knowingly billed for inpatient services when only lower paying outpatient or observational services were warranted. HMA was also accused of paying physicians for patient referrals and inflating emergency department facility fees.

More: HCA accused of ‘money grab’ in expansion of trauma centers

The SEIU isn’t the only one who has accused HCA of similar practices. A lawsuit, filed in 2018 by a whistleblower doctor in Florida, claims HCA hospitals induced physicians to increase inpatient admissions “without regard to whether such admissions were medically necessary.” Dr. Camilo Ruiz says in the suit, which he stopped pursuing in 2020, that hospital administrators heavily scrutinized observational numbers, setting up a de facto quota for higher-paying inpatient admissions.

The SEIU report was first taken to HCA directly which responded through a filing with the Securities and Exchange Commission. The union, which was in the midst of labor disputes at several HCA hospitals, also enlisted a union-backed investment group to raise concerns with the SEC.

“They don’t do anything. They just say, ‘We already answered this.’ So we need to go to the agencies that do have the authority,” says Joseph Lyons, the research coordinator for the SEIU who authored the report.

Whether or not HHS launches an inquiry, the oversight subcommittee is doing its own bit of investigating. Pascrell sent a letter to HCA CEO Sam Hazen requesting reams of information about how doctors are incentivized to admit patients. Asked for comment, HCA spokesperson Harlow Sumerford says the company will respond to Pascrell’s request but also continued to dismiss the SEIU’s data.

“Our hospitals are staffed by physicians, clinicians and nurses who work tirelessly to ensure our patients receive medically necessary care in the appropriate clinical setting,” Sumerford said in a statement. “We believe that our operational processes and procedures are working well.”

Correction: An earlier version of this story misstated the status of a whistleblower suit filed against HCA. Camilo Ruiz’s suit was dropped in 2020 and is no longer pending.