Is Technology Perpetuating Medicare Fraud?

Scott Mace, for HealthLeaders Media , December 11, 2012

According to more than 100 people interviewed by 60 Minutes over the course of a year-long investigation, HMA institutionalized these corporate goals through computer software that HMA had installed in every emergency room. According to Jeffrey Hamby, a former emergency room doctor at HMA's Summit Medical Center in Van Buren, Ark., this software had been customized by HMA to order a battery of predetermined tests once a patient's chief complaint and age were recorded. Rankin said these tests were ordered even before the patient was seen by the treating physician.

When doctors decided to send an emergency room patient home, the computer would often intervene, Hamby said. "The minute I hit home, it says 'qualcheck,' and then it comes up with a warning. This patient meets criteria for admission. Do you want to override?" The ex-employees also allege that the software generated printed reports, some of which 60 Minutes displayed, evaluating each doctor's performance and productivity. Doctors who hit corporate admission goals received praise from company managers, and those who didn't "knew it," said Kroft.

The broadcast also quoted Paul Meyer, former director of compliance for HMA and a 30-year veteran of the FBI, accusing HMA of Medicare fraud based on his audit of four hospitals in Texas, Florida, and Oklahoma.

Even before the broadcast aired, HMA took the offensive, holding a November 30 webcast for analysts. In short, the company denies allegations of requiring emergency room physicians to meet any admission quotas. HMA further says that 60 Minutes did not produce a single patient who it could say was admitted unnecessarily.

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