- http://www.cbsnews.com/video/watch/?id=50136261n
- http://www.cbsnews.com/8301-18560_162-57556670/hospitals-the-cost-of-admission/
- http://www.cbsnews.com/8301-504803_162-57556625-10391709/1993-mike-wallace-reports-on-er-docs/
Provide names of other journalists involved.
Michael Rey, Oriana Zill
List date(s) this work was published or aired.
12/2/2012
Provide a brief synopsis of the story or stories, including any significant findings.
Topics: Hospital Emergency Room Management/Care, Health Care Costs, Unnecessary Treatments/Testing, Medicare Fraud… Synopsis: With estimates for waste, unnecessary care and fraud in health care in the hundreds of billions, 60 Minutes’ investigation into hospital emergency room practices provided a window into the kind of conduct that causes health care costs to go out of control. For more than a year, we looked into the admission and billing practices of Health Management Associates. It’s the fourth largest for-profit hospital chain in the country with revenues of $5.8 billion last year, nearly half of that coming from Medicare and Medicaid programs. We reviewed thousands of pages of documents, talked to more than 100 current and former employees and heard a similar story over and over: that HMA relentlessly pressured its doctors to admit more and more patients — regardless of medical need — in order to increase revenues. Several doctors and clinicians spoke on camera, describing how control was exerted with corporate wide computer software called Pro-MED, which was installed in every emergency room. The program they described automatically ordered an extensive battery of tests — many of them unnecessary — as soon as a patient walked into the emergency room. Medical decisions on admissions were remotely tracked and repeatedly called into question by non-physician administrators. Revenue driven goals for each doctor were set – on rates of admission and testing. We also sat down with HMA’s former compliance director Paul Meyer, a former FBI agent who once headed the bureau’s Health Care Fraud unit in Miami. He repeatedly raised the issue of inappropriate admissions with HMA’s senior management: he found clear evidence that several HMA hospitals he monitored for compliance were committing fraud, inappropriately pressuring doctors and nurses for more admits, and intentionally submitting bills to the government that did not meet the appropriate prescribed criteria for admission.
Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
Court records, internal company documents and correspondence
Explain types of human sources used.
Current and former employees and executives of the hospital chain and their contract staffing firms. Several national authorities in Emergency Medicine, treatment protocols/order sets, and ER operations/finance. Experts on electronic medical records and decision support software packages.
Results:
A DOJ investigation is still active.
Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
No.
Advice to other journalists planning a similar story or project.
Given that the federal investigation was still ongoing, sources were important. After looking at ongoing litigation (wrongful termination cases etc)…develop sources at all levels, but particularly among former CEOs, former nursing ER directors, former ER directors for the contract staffing companies, and the former employees who were in charge of Clinical IS/implementation/training.