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As Whistleblowers and Quality Care Advocates, Hospitalists are the Conscience of Healthcare

Posted  February 28, 2022

Thursday, March 3, 2022 is National Hospitalist Day, a day we recognize the contributions of the specialist care doctors and other professionals who provide quality care to sick and vulnerable patients in a hospital.  As the fastest growing specialty in modern medicine, hospitalists are a critical part of the nation’s health care service delivery system.

Less noted but no less important, hospitalists also play a vital role as whistleblowers, drawing attention to corporate practices that maximize profits at the expense of patient care. In recent years, hospitalists have repeatedly exposed hospital systems for various schemes that harm patients and bilk taxpayers.

Hospitalists as Whistleblowers

Hospitalists have shined a light on the troubling practice of hospitals unnecessarily admitting patients from the emergency department, without respect to medical need.  Since hospitals receive higher reimbursements from Medicare and other healthcare payers for inpatient admissions, corporate efforts to boost profits frequently drive this unscrupulous scheme.

Hospitalists have initiated or supported whistleblower lawsuits concerning unnecessary inpatient admissions against Community Health Systems, Health Management Associates, and Prime Healthcare. The federal government has moved aggressively to stop unnecessary inpatient admissions, not only because it saps limited healthcare dollars, but also because of the real risk of patient harm. Hospitals and health systems have paid hundreds of millions of dollars to settle such lawsuits.

Such whistleblower lawsuits are brought under the federal False Claims Act (FCA), which provides for monetary rewards for whistleblowers who expose fraud against government healthcare programs.  In the process, hospitalists have received substantial whistleblower awards for helping to stop this and other major fraud issues, like upcoding.

SEIU Study of Hospital Admission Rates at HCA

Emergency room sign - Hospitalists play important role in reporting healthcare fraudA recent investigative report by the nation’s largest healthcare union, the Service Employees International Union (SEIU), takes aim at America’s largest hospital operator, HCA Healthcare, for its unusually high emergency room admission rates.  Through a deep analysis of Medicare claims data, the report shows that HCA’s emergency department admission rates have been well above the national average in most recent years. SEIU estimates this potentially fraudulent practice has may have resulted in more than $1.8 billion in Medicare overpayments from 2008 to 2019.

SEIU is not alone in bringing these concerns to light. A hospitalist physician whistleblower at an HCA hospital alleged the company engaged in similar practices in an FCA lawsuit filed in 2017. The whistleblower claimed that HCA hospitals demanded that physicians increase the volume of patients they admitted as inpatients through the emergency department or face penalties, including termination. Other whistleblowers have alleged that HCA unduly interferes with physician decision making, directing doctors to discharge patients even when the physician disagrees.

Given HCA’s size and the government’s interest in stopping improper inpatient admissions, the findings of SEIU’s report on HCA may signal the beginning of intense scrutiny on the healthcare giant.

Recognizing National Hospitalist Day

On National Hospitalist Day, we recognize and celebrate the individuals who are the heart of the hospital medicine community. Hospitalists deliver quality care and show compassion to their patients.  Equally important, as the conscience of a hospital, hospitalists can help curb corporate decisions that put profits over patients.

If you have information about hospital fraud or another type of fraud in healthcare, you could have a whistleblower case under the False Claims Act and you may be eligible for a reward. Contact our team of whistleblower lawyers to learn more.

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Tagged in: FCA Federal, Healthcare Fraud, Hospital Fraud, Importance of Whistleblowers, Upcoding,