Yesterday, I read multiple articles about my local community
nonprofit hospital defrauding Washington State Medicaid and the federal government
for millions of dollars. This hospital encouraged neurosurgeons to perform unnecessary
spinal surgeries in order to generate higher revenues for five years.
To give you an idea of the scale, St. Mary-Providence only
has 142 beds, which is a small hospital, by comparison, Providence Hospital in
Spokane has 674 beds, which is considered large by U.S. standards. The head of
a much larger hospital earned less than the head of this tiny hospital, because
of the Providence incentive system which rewards increased volume in complex
procedures. Not comforting to know your doctor works on a lucrative bonus plan versus
the best evidence-based practices.
The overbilling occurred over a five-year-period at St. Mary’s
ending in 2018, when the unethical and abusive neurosurgeons were forced to
resign. But Providence did not report them to the Attorney General, for that
would have ensnared them in the overbilling scheme as well. The corporate financiers
were content to keep raking the money in, despite patient health risks, and higher
costs for all consumers.
Fortunately, the former administrator for the neuro unit
became a whistleblower and got the case started with the Washington State
Attorney General, Bob Ferguson’s Office. Because of the excellent work of his
team, Providence has been found guilty of fraud, will pay a twenty-two million
dollar fine, and will be on a five-year-probationary review. Imagine if we
looked at all of Providence’s hospitals in all seven states, how much
overbilling would we find? Afterall when the Affordable Care Act passed, Providence
made so much money it created its own venture capital fund rather than lower its
fees for services.
Providence Hospitals named in the lawsuit: Providence Centralia Hospital, Providence St. Joseph Hospital, Providence Mount Carmel Hospital, Providence Regional Medical Center, Providence St. Peter Hospital, Providence Holy Family Hospital, Providence Sacred Heart Medical Center, Providence St. Mary Medical Center, Swedish First Hill Campus, Swedish Cherry Hill Campus, Swedish Ballard Campus, Swedish Issaquah Campus, Swedish Edmonds Campus, and Kadlec Regional Medical Center. Providence also operates hospitals in Alaska, Montana, Oregon, and California.
The most galling are the finance
people working in hospital corporations who create these schemes and see nothing
wrong with paying someone an exorbitant compensation package in a tiny rural
hospital. This is one of the problems with nonprofit hospital groups, their
compensation packages are often opaque, because there are no shareholders and
disclosure is limited. The executive of St. Mary Medical Center is no exception
in the Providence compensation, many of their executives earn ten million a
year.
Providence Health was also found guilty of deceptive billing
practices, because the nonprofit hospital did not make patients aware of their charity
care options. In other words, the nonprofit Catholic hospital saw nothing
wrong with bilking low-income people for care, as long as their venture capital
fund was doing well.
In a previous post, I
wrote about a Pennsylvania judge ruling that another nonprofit hospital group did
not deliver enough uncompensated care to qualify as a nonprofit entity. [i]
This is a national healthcare problem, which can only be cured by further
government interventions in regulation of pricing, financial disclosure, and
enforcement.
Imagine how many more nurses and mental health specialists
we could have actually helping patients if we had a healthcare system which is
not based on profits. The only way this abuse is ever going to end is when Americans
wake up and adopt a national healthcare system and yes, that will mean hospital
administrators won’t be making ten million dollars a year. And that would be
better for all of us.
And this is the healthpolicymaven signing off encouraging
you not to sign blanket release forms for procedures, do stipulate that for
which you agree and decline.
Roberta Winter is an independent healthcare analyst and journalist who accepts no money from any sector of the U.S. healthcare system. She has been interviewed on publicinterestpodcast.com and is the author of a guidebook to the U.S. healthcare system, published by Rowman and Littlefield in 2013. https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972
References
Gamble, M. (22, February 24). Beckers Hospital
Review. Retrieved from Beckers Hospital Review.com:
https://www.beckershospitalreview.com/legal-regulatory-issues/washington-sues-providence-over-collection-tactics.html
Hagar, S. (2022, April 13). More details emerge
on Providence St. Mary Medical Center's $22.7 million insurance fraud
settlement. Retrieved from Union Bulletin:
https://www.union-bulletin.com/news/courts_and_crime/more-details-emerge-on-providence-st-mary-medical-centers-22-7-million-insurance-fraud-settlement/article_9ef81200-bab2-11ec-9bf3-03450d16ba13.html
National Union of Healthcare Workers. (2022, April
14). Providence St. Joseph Watch. Retrieved from NUHW.org:
https://nuhw.org/providence-st-joseph-watch/executive-salaries/
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