Archive for the ‘Medicare’ Category

Senators launch fraud inquiry of Md. hospital –

February 20, 2010

St. Joseph Medical Center in Towson, Maryland, has been the subject of recent lawsuits, news reports and a myriad of other woes.  Now the Baltimore Sun reports that its conduct will be the subject of a U.S.  Senate investigation – Senators launch fraud inquiry of Md. hospital –

The controversy swirling around the hospital concerns the alleged placement of unnecessary cardiac  artery stents in patients at the hospital by one of its former (now terminated) cardiologists, Dr. Mark Midei.

After a lawsuit was brought in Maryland by one of Dr. Midei’s former patients, the hospital issued a statement to a local news station, WBAL:

“St. Joe’s was guided by the belief that it has a moral and ethical responsibility to inform these patients of what happened. This is consistent with our mission and core values. It was the right thing to do,” the representative said through a statement.

“Questions about potential liability remain to be resolved. SJMC takes its responsibility to patients very seriously, which is why we conducted a review and notified patients and physicians. Our focus has been and will continue to be to put patients first,” the representative continued.

In a follow-up report written today, February 20, 2010, the Baltimore Sun reports:

Federal lawmakers have asked St. Joseph Medical Center to turn over three years of billing records and other documents related to cardiac care, saying they are troubled by reports of unnecessary coronary stents implanted at the Towson hospital and want to investigate for signs of Medicare fraud.

Montana Sen. Max Baucus and Iowa Sen. Charles E. Grassley – the top Democrat and senior Republican, respectively, on theSenate Finance Committee – also asked the hospital for records of its financial relationship with manufacturers of the medical devices. They set a March 12 deadline, saying their committee was launching an inquiry as part of its role “to protect taxpayer dollars from waste, fraud and abuse.”

An internet search on this story quickly reveals that a number of law firms have gotten into the fray.  Most notably, a class action lawsuit has been filed by Billy Murphy’s law firm and the Law Offices of Peter Angelos alleging, among other claims, fraud on the part of the hospital.

In a statement given to, Billy Murphy said:

“This is the worst abuse of the public trust we have seen in recent memory by a hospital in which patients place their confidence in seeking care and treatment,” said William “Billy” Murphy, Esquire.

Murphy added, “It is unfortunate that an institution such as St. Joseph, which has served so many people so well for so many years, would have allowed such a practice to have occurred.”

In today’s article, The Sun reports that the hospital has pledged to fully cooperate with the Senate committee’s investigation.

“Transparency and cooperation are in the best interest of the hospital’s patients, physicians, employees and community,” they said in a statement released Friday.

Dr. Midei has been recognized for years to be one of the area’s leading cardiologists.  As Billy Murphy said in his statement, St. Joe’s has held the reputation of being one of the area’s best hospitals serving many in the community for decades.  How could it all have gone so bad?   Seems like the story is just beginning…and gets worse almost by the day.

Long-Term Care Hospitals Proliferate Without Much Scrutiny –

February 10, 2010

Yet another detailed investigative report by the NY Times brings a series of real-life vignettes of bad care and human suffering to the forefront of public awareness.

Alex Berenson, a NY Times reporter for just over 10 years, reported yesterday on conditions in long term care facilities, fostered by minimal governmental oversight, Medicare reimbursement issues and lack of medical supervision.

The following is an excerpt from his article and tells the story of a 46 year old patient, Tina Bell-Jackman, and the tragic events that led to her death on June 26, 2007.

On the night of June 26, 2007, Ms. Bell-Jackman turned restlessly in her bed in Room 7 at Select Specialty Hospital of Kansas City, a small medical center that specializes in treating chronically ill patients. Ms. Bell-Jackman, a 46-year-old with diabetes, had been hospitalized at Select for five weeks, was increasingly agitated and could not speak because of a surgical hole in her throat. Her physicians had ordered the hospital to keep a sitter with her.

But at 8 p.m., the sitter left, according to a state court lawsuit and a Medicare inspection report. Left alone, Ms. Bell-Jackman tried to get up. Around 9:30 p.m., staff members tied her down with wrist restraints. Around 12:15 a.m., after the restraints had been removed, a nurse injected her with a sedative to calm her.

Berenson reports that in the last 25 years more than 400 long-term acute hospitals have opened in the United States.  He cites several key problems pervasive in many of these facilities.

  • Serious and repeated violations of Medicare rules
  • Rapid growth of these for-profit facilities – “Medicare rules that offer high payments for hospitals that treat patients for an average of 25 days or more.”
  • Despite the rapid expansion of long-term care hospitals and the serious illnesses they treat, Medicare has never closely examined their care. Unlike traditional hospitals, Medicare does not penalize them financially if they fail to submit quality data, he says.
  • Few of these facilities have doctors on staff yet treat many very ill patients who are often in need of urgent physician care.
  • Under Medicare payment rules, traditional hospitals often lose money on patients who stay for long periods. So they have a financial incentive to discharge patients to long-term hospitals, which then receive new Medicare payments for admitting the patients. Both hospitals benefit financially.

These are to name a few of the inherent defects in such institutions.  Those of us who handle cases involving such lack of quality patient care have seen our own ‘Tina Bell-Jackman’ stories:  a patient discharged to a long term care facility for wound care and a staff that (as written in their own progress notes) waits for days to have a wound-vac representative come to ‘teach’ them how to use this critical piece of equipment; repeated stories of restraints and sedatives to replace ‘sitters’ for those in need of such personal supervision – the horror stories go on-and-on.

Berenson further reports on the financial incentives that have driven the proliferation of such facilities:

Long-term care hospitals now treat about 200,000 patients a year, including 130,000 Medicare patients — at a projected cost of $4.8 billion to the government this year, up from $400 million in 1993.

Whether it’s a report on 60 Minutes about outright fraudulent Medicare  claims or reports like those of Mr. Berenson – isn’t there a clear lesson to be learned?  If you are going to try to fix the healthcare system, maybe, just maybe, a good place to start is with the Medicare system.  After that gets fixed, maybe then a dialogue about things like ‘tort reform’ might be relevant – maybe.  Ever consider that if it weren’t for lawsuits and reporters, stories like this would just be buried – literally and figuratively?