Hospital chain accused of Medicare fraud in California

On Behalf of | Feb 11, 2022 | Fraud

One of America’s largest hospital chains is accused of Medicare fraud due to excessive, unnecessary emergency room admission rates. The Service Employees International Union covers five years of data, 2014-2019, that supports these allegations. SEIU analyzed Hospital Corporations of America Medicare reports, lawsuits, whistleblower complaints and more to reach their conclusions.

The data suggests that HCA’s average emergency department admission rate was consistently higher than the national average between 2014 and 2019. The HCA’s average ER admission rate reached 10% above the state average ER department admissions in California.

How does Medicare hospital fraud impact Los Angeles residents?

Unplanned hospital admissions cost patients thousands of dollars. Most Medicare recipients are seniors on a fixed income with limited savings and are the most vulnerable to hospitalizations, especially during a severe health crisis.

Medicare over-billing has been a consistent reoccurring event that impacts low-to-moderate-income seniors’ financial and physical health. Private doctor offices that contract with certain hospitals also feel the impact, and some are forced to turn away Medicare patients for non-emergency or preventative care.

For this reason, lawsuits are a constant issue for medical facilities. Criminal defense is expensive, and hospitals pass these costs on to Medicare patients. The added costs of unnecessary ER hospital admissions intensify the burden on the already economically strapped-for-cash Medicare population.

What is the cost in dollars of hospital Medicare fraud?

Although 5-10% seem like small numbers, when you figure actual dollars, the costs are upwards of $1 billion in excess Medicare payments attributed to unnecessary ER hospital admissions. The data shows that these recurring incidents are not limited to California but also throughout the nation, indicating an unacceptable pattern of behavior.

Not all hospitals are guilty of fraud, but criminal defense costs against alleged Medicare fraud can impact all hospitals and health care accessibility. When the case is decided, HCA might receive fines in the tens of thousands of dollars and incarceration for those found guilty of these violations.