HCA cardiac procedures under federal scrutiny

Hospital Corporation of America (HCA), the nation's largest for-profit hospital chain, is under federal scrutiny due to a pattern of aggressively implanting cardiac stents, The New York Times reported.

The 163-hospital chain based in Nashville, Tenn., was aware of overly aggressive stent insertions--in some instances, where operating room nurses could observe no arterial blockage at all--as early as a decade ago, according to the Times. However, it took no action to address the issue and even fired a nurse who had raised concerns, the newspaper noted.

The article suggested HCA aggressively pursued stent insertions and other cardiac procedures at its Florida facilities to grow revenues and profit margins.

Earlier this week, HCA reported both strong revenue and profit growth for the second quarter ending June 30. However, it also disclosed that the U.S Attorney's office in Miami had requested documentation regarding cardiac procedures at 10 of its hospitals, according to a document filed with the U.S. Securities and Exchange Commission.

Cardiac issues--particularly those involving stent insertions--have been a leading trigger for RAC, MAC and commercial audits, according to a number of interviews FierceHealthcare has undertaken in recent weeks with both hospital officials and experts on the audit process.

In a statement issued in response to the Times article, HCA noted that the medical necessity for cardiac stents may be widely interpreted by healthcare professionals.

"There is variation across the country, between regions, within regions, and even within the same medical staff or medical group regarding this issue," HCA said. "In addition, even when expert outside reviewers are engaged, they, themselves, may disagree on the same patient data. Thus, variation and  disagreement among physicians indicates the difficulty in determining the medical necessity of these procedures."

For more:
- read the New York Times article
- here's the SEC filing
- read the HCA statement (.pdf)