HCA officials on Monday said that the Department of Justice (DOJ) is investigating the "medical necessity" of cardiac procedures performed at the for-profit health system's Florida hospitals.
According to Bloomberg News, the investigation is part of the federal government's ongoing effort to scrutinize the health care industry and crack down on potential fraud.
DOJ investigation
In a regulatory filing on Monday, HCA—the largest for-profit hospital operator in the country—said that the civil division of the U.S. attorney's office in Miami has requested information on "reviews assessing the medical necessity of interventional cardiology services provided at any company facility (other than peer reviews)."
According to HCA, such reviews have been conducted at about 10 HCA hospitals in Florida. A spokesperson for the U.S. attorney's office in Miami could not confirm the investigation.
NYT details investigation into cardiac procedures
HCA’s announcement of the DOJ probe came just ahead of a New York Times investigation into the Nashville-based organization's cardiology services.
The Times found that HCA's medical necessity reviews "uncovered evidence as far back as 2002 and as recently as late 2010 showing that some cardiologists at several of [HCA's] hospitals in Florida were unable to justify many of the procedures they were performing." Internal reports suggest that some physicians made misleading statements in medical records to help justify the procedures, the Times reports.
According to the Times, HCA has not provided evidence that it notified federal Medicare officials, the state Medicaid program, or private insurers of the reviews' findings or offered reimbursements for the procedures, as required by law.
HCA responds to NYT
However, HCA says the reviews were "not, by any means, definitive," and the physicians in questions say the reviews did not accurately reflect the medical care provided to patients.
The company also says it took all necessary steps to improve patient care and "investigate areas of concern."
In a statement on its website, HCA said, "These physician-driven decisions have been and are the subject of much debate within the cardiology community. Accordingly, there is variation across the country, between regions, within regions, and even within the same medical staff or medical group regarding this issue."
Meanwhile, HCA noted that the rate of cardiac procedures at its hospitals was in line with national statistics, and the number of cardiac catheterizations and stent implantations performed by its physicians has fallen across the past decade, the Wall Street Journal reports.
A larger federal effort to crack down on fraud
According to the Wall Street Journal, the HCA probe is part of a larger federal effort to address health fraud and scrutinize medical interventions. Modern Healthcare also reported last month that the DOJ is investigating hospitals for possible violations of the False Claims Act, an anti-fraud statute, after learning that thousands of implantable cardioverter defibrillator (ICD) procedures may not have been medically necessary.
Meanwhile, GlaxoSmithKline, Johnson & Johnson, and Teva Pharmaceuticals have all announced actions by the federal government in the last month, according to Bloomberg News (Wilde Mathews/Weaver, Wall Street Journal, 8/6; Nussbaum, Bloomberg News, 8/7; Abelson/Creswell, New York Times, 8/6; Carlson, Modern Healthcare, 8/6 [subscription required]).
