Congressman asks HHS to investigate HCA Healthcare's ED admissions practices

Allegations against HCA Healthcare of improper emergency department admissions practices have caught the attention of a key lawmaker, who is now calling on the Department of Health and Human Services (HHS) to open an investigation.

Tuesday, Rep. Bill Pascrell, D-New Jersey, chair of the House Ways and Means Committee’s Subcommittee on Oversight, penned a letter to HHS Secretary Xavier Becerra asking for his agency’s help to settle “disturbing questions about HCA’s corporate policies and practices.”

The congressman’s letter largely leaned on allegations by the Service Employees International Union (SEIU), which earlier this year released a report (PDF) indicating that the hospital chain may have collected $1.8 billion in excess Medicare payments since 2008 thanks to medically unnecessary emergency department admissions.

“There have also been allegations that HCA sets corporate admission targets and routinely threatens retaliation against staff if those targets are not met,” Pascrell wrote in reference to the union’s report. “HCA’s long-standing joint venture with EmCare, a subsidiary of the private-equity-owned Envision Healthcare (Envision), may play an essential role in the setting and/or implementation of these admissions targets.”

The alleged practices would constitute an improper use of tax dollars while the unnecessary admissions could impose negative “cascading effects on patients and workers,” Pascrell wrote.

Alongside the request to HHS, Pascrell also wrote to HCA CEO Sam Hazen (PDF) requesting the company submit directly a slew of information by Sept. 27.

The lawmaker told HCA he is interested in reviewing information related to potential physician incentives for admissions or referrals, physician performance data, a description of any internal audit or review processes related to the clinical necessity of admissions and other details on facility staffing.

HCA is among the country’s largest health systems with 182 hospitals and roughly 2,300 ambulatory sites of care. It logged $58.75 billion in revenues and almost $7 billion in net income across 2021.

HCA’s facilities admitted a higher percentage of emergency department patients than the national average and more than can be explained by geography and diagnoses, according to Medicare data cited in SEIU’s report and in a more recent Securities and Exchange Commission complaint filed by the Strategic Organizing Center Investment Group (which works with the pension funds of SEIU and other major labor unions).

HCA has previously rebuffed allegations against its emergency department admissions practices, saying that it found no issues during internal reviews and received independent third-party audits.

In an email statement, the company said it is reviewing Pascrell's letter and will respond to his information requests, but that the concerns he referenced "appear to be similar" to those it had addressed in the past. 

"Our hospitals are staffed by physicians, clinicians and nurses who work tirelessly to ensure our patients receive medically necessary care in the appropriate clinical setting," the company said in an email statement. "We believe that our operational processes and procedures are working well and that we are meeting the healthcare needs of our patients and communities."

SEIU International President Mary Kay Henry said her organization applauds Pascrell's interest in the matter. 

"For years, caregivers and other frontline workers at HCA hospitals have been calling on HCA to protect workers and patients by investing in quality care," she told Fierce Healthcare in an email statement. "Instead, it seems, executives have prioritized huge profits and payouts to its richest shareholders. It's time that changed and HCA put care first."