Columbia/HCA billing under review U.S. investigating whether hospitals overstated illness to increase reimbursement

March 29, 1997|By BLOOMBERG NEWS

WASHINGTON -- The federal government is trying to determine whether Columbia/HCA Healthcare Corp. has been overbilling for care of Medicare patients, Bruce Vladeck, chief Medicare administrator, said yesterday.

The review involves Columbia/HCA hospitals in Kentucky and two or three other states, Vladeck said in an interview.

He would not name the other states, but there were reports that Florida, Texas, Illinois and Nevada are among states in which the FBI is investigating practices by the nation's largest hospital chain.

The review is being conducted to see whether Nashville, Tenn.-based Columbia/HCA uses a practice called upcoding, in which a hospital overstates the severity of a patient's medical condition to increase its reimbursement from Medicare, the health insurance program for the elderly.

Vladeck said the Clinton administration is still trying to determine whether Columbia/HCA broke the law. "If we think it is just pushing the edges of what is appropriate, we'll get our money back," Vladeck said. "If there has been some false claims, we will refer it" to federal investigators in the Inspector General's office of the U.S. Department of Health and Human Services.

A spokeswoman for Columbia/HCA, which has $20 billion in annual revenue and owns more than 340 hospitals, 140 surgery centers and has 550 home health agencies in 37 states, said the company has not been informed of the billing investigation. She had no other comment.

Though the chain has become a major target of federal investigators, company investors played down the significance of the probes.

"It's a rainstorm passing overhead," said Phillip Schettewi, managing partner in the Washington office of Loomis Sayles, which owns more than 2 million Columbia/HCA shares.

Last week, federal investigators raided Columbia/HCA's four El Paso, Texas, hospitals and more than 20 physicians' offices, seizing boxes of documents. Investigators have been unwilling to comment.

The government has been under pressure from Congress to examine whether any hospitals are paying doctors to refer patients to fill their beds.

Rep. Fortney "Pete" Stark of California, the top Democrat on the House panel that oversees Medicare, is a major critic of Columbia/HCA and has been pushing Vladeck to investigate whether the hospital chain has violated laws that restrict physician referrals to services in which they have a financial stake.

Pub Date: 3/29/97

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