HCA is the largest for-profit hospital chain in the United States with 163 facilities located throughout the country, mostly in the Southeast. Part of the driving force behind the chain's profitability is its cardiology business, particularly its cardiac testing and heart surgeries. Now, thanks to a whistleblowing former-HCA nurse, it has become publicly known that many of HCA's cardiac procedures, particularly those performed at several Florida facilities, were done unnecessarily, increasing profits and putting patients at risk of medical complications.
Healthcare fraud is not exactly new to HCA. In 2000, the hospital chain reached a series of agreements with the Justice Department over claims they fraudulently billed Medicare. As part of those settlements, HCA was ordered to pay $1.7 billion in fines and reimbursements. The company also had to enter into a Corporate Integrity Agreement, in effect until 2008, which detailed exactly what type of behaviors and discoveries had to be reported to authorities if discovered. The agreement also established stiff fines in case HCA failed to stick to the agreement.
Despite the strict nature of this agreement, the New York Times discovered that, although HCA discovered evidence of unnecessary heart procedures being performed at their hospitals as far back as 2002, the company did their best to conceal evidence of this fact from authorities, even when some of their physicians were caught falsifying patients' medical records and making misleading statements.
In the spring of 2008, former HCA nurse C.T. Tomlinson, employed at the company's Lawnwood Regional Medical Center, noticed that a doctor in the hospital's cardiac catheterization lab was preparing to place a stent in a heart patient, despite the fact that there were no visible blockages in images of the patient's artery. Tomlinson question the doctor, who mocked him for not noticing the artery's supposed 90% blockage.
In a 2010 letter to HCA's chief ethics officer, Tomlinson reported the misconduct, along with information about other unnecessary procedures he had witnessed at the facility. While his letter did trigger an internal investigation, it also resulted in the company's failure to renew his contract. Internal HCA documents obtained by the Times confirmed that his non-renewal was a direct result of his whistleblowing.
In the wake of Tomlinson's discovery, it became clear that HCA had long been aware of unnecessary procedures being performed. In fact in 2003, the company hired outside ethics reviewer CardioQual to assess potentially unnecessary cardiac procedures being performed at HCA's Bayonet Point medical center. The subsequent report revealed that as many as 43% of the angioplasty procedures performed at the facility were outside reasonable and expected medical practice.
The numbers were so egregious that CardioQual concluded the activities weren't just erroneous, but intentional misconduct on the part of the facility physicians. In internal communications following the report's release, it was made evident that HCA withheld the details of their discoveries of that and other forms of fraud from the government and the public, despite being bound by the Integrity Agreement.