Steps to reduce the cost of health care continue with the implementation of health information technologies and the increase of accountable organizations, but the cost of some medical bills may be more premeditated than we think.
The Justice Department is currently investigating into Health Management Associates' (HMA) financial statements due to reports that the for-profit health network allegedly tried to admit as many patients into its hospitals as possible, even if the course of action did not require an overnight stay.
DOJ's report found instances when admitting a patient to one of HMA's locations was not mandatory. Examples included an infant with a 98.7 temperature for a fever or getting "at least half" of adults over 65 years old into a hospital bed. Ultimaterly, the goal was to keep reimbursements from the Centers for Medicare and Medicaid Services high, according to the New York Times.
Staff members who raised questions on HMA's supposed accounts receivable management practice would usually get fired. It didn't matter if you were a member of the emergency department or Ralph Williams, who has more than 30 years of accounting experience in hospital settings.
The news source explained when Williams was hired, he asked an outside consultant to look into HMA's financial statements to see if the results were similar to Williams' findings. When results did show abnormally high admission rates, Williams questioned HMA about it. In response, his supervisor told him to get rid of these documents.
HMA's practices were addressed time and again, but a resolution to these problems did not occur. Now, HMA is facing a qui tam lawsuit, which consists of one lawyer representing multiple whistle blowers who plan on testifying about these alleged activities.
"It's not a doctor in there watching those statistics — it's the finance people," attorney Janet Goldstein told the Times.
On top with the DOJ on their heels, timing for HMA couldn't be worse, as the network acquired Community Health Systems for $7.6 billion. This recent acquisition makes HMA the second-largest for-profit hospital chain in the United States. It is unclear what the future holds for HMA, but medical billing departments need to keep their departments compliant to industry practices.
If there is a time when accounts receivable financing is unsure that their transactions are being properly processed, look into contacting Professional Medical Services to receive another opinion.