Update on "The Cost of Admission"

60 Minutes

16 Feb 201400:57

Summary

TLDRThe report highlights a whistleblower case involving Health Management Associates (HMA), the fourth-largest for-profit hospital chain in the U.S. Doctors accused HMA of pressuring them to admit emergency room patients unnecessarily, setting quotas regardless of medical need. The U.S. Department of Justice has now joined lawsuits targeting these practices, particularly focusing on former CEO Gary Newsome, who has since retired and now runs a Mormon mission in Uruguay. The case sheds light on Medicare fraud and unethical hospital admissions.

Takeaways

📝 The script provides an update on a story first reported a year ago called 'The Cost of Admission'.
🏥 Doctors at Health Management Associates (HMA), the fourth-largest for-profit hospital chain, reported being pressured to admit emergency room patients regardless of medical need.
🎯 HMA set quotas for doctors to meet, with one department chief stating that 20% of patients needed to be admitted, or someone would be fired.
⚖️ The U.S. Department of Justice has joined eight whistleblower lawsuits against HMA, focusing on unnecessary hospital admissions and Medicare fraud.
🚨 The lawsuits allege that HMA engaged in fraudulent activities by admitting patients who didn’t require hospitalization.
👤 Gary Nome, HMA's former Chief Executive, is singled out as being responsible for the scheme.
🚪 Gary Nome retired last summer and is currently running a Mormon mission in Uruguay.
💼 The lawsuits indicate significant federal involvement, raising the stakes for HMA's accountability.
📊 The focus on Medicare fraud suggests widespread financial implications within the healthcare system.
📺 The segment is from the show '60 Minutes', hosted by Steve Croft, who promises to return with another edition next week.

Q & A

What is the main focus of the story being updated?
-The story focuses on Health Management Associates (HMA) and the allegations that they pressured doctors to admit emergency room patients to their hospitals, regardless of medical need, as part of a scheme to meet quotas.
What unethical practice was HMA accused of?
-HMA was accused of pressuring doctors to meet quotas by admitting a specific percentage of emergency room patients, regardless of whether they needed hospitalization.
Who was behind the alleged scheme at HMA according to the report?
-Gary Nome, HMA's former Chief Executive, was singled out as being behind the scheme of unnecessary hospital admissions.
What consequence did doctors at HMA face if they didn't meet admission quotas?
-Doctors were reportedly told that if they didn’t admit 20% of patients, someone would get fired, indicating pressure to meet admission quotas.
How has the U.S. Department of Justice responded to these allegations?
-The U.S. Department of Justice has joined eight whistleblower lawsuits against HMA, targeting unnecessary hospital admissions and Medicare fraud.
What role did whistleblowers play in this investigation?
-Whistleblowers played a significant role, as the Department of Justice joined eight lawsuits brought by them, highlighting the issue of unnecessary admissions and Medicare fraud at HMA.
What is Gary Nome’s current role after leaving HMA?
-After retiring from HMA last summer, Gary Nome now runs a Mormon mission in Uruguay.
What type of fraud is HMA accused of engaging in?
-HMA is accused of Medicare fraud, specifically related to unnecessary hospital admissions to inflate revenue.
How large is HMA in the U.S. healthcare industry?
-HMA is the fourth-largest for-profit hospital chain in the United States.
What is the next step for the 60 Minutes show according to the transcript?
-The 60 Minutes show will return next week with another edition, as stated by Steve Croft at the end of the report.

Outlines

00:00

📰 Update on Healthcare Scandal

This paragraph provides an update on a story reported a year ago regarding Health Management Associates (HMA), a major for-profit hospital chain. Doctors at HMA alleged that the company pressured them to admit emergency room patients regardless of medical necessity, even setting quotas for admissions. The paragraph mentions a chief who threatened job loss if admission targets were not met.

⚖️ Legal Action Against HMA and Its Leadership

The U.S. Department of Justice has joined multiple whistleblower lawsuits against HMA, focusing on unnecessary hospital admissions and Medicare fraud. The lawsuits specifically target HMA's former Chief Executive, Gary Nome, for orchestrating the scheme. Nome retired last summer and is currently involved in a Mormon mission in Uruguay.

📺 Stay Tuned for More on 60 Minutes

Steve Croft, the presenter, concludes the update by stating that the investigative show '60 Minutes' will return next week with another edition, signaling the end of the report.

Mindmap

Keywords

💡Cost of Admission

This phrase refers to the issue of hospitals admitting patients unnecessarily, potentially to increase revenue. In the context of the video, it is the central theme as it discusses how doctors were pressured to admit patients without medical need to boost the hospital's profits.

💡Health Management Associates (HMA)

HMA is identified as the fourth largest for-profit hospital chain in the country. The video script highlights that HMA is under scrutiny for pressuring doctors to admit patients unnecessarily, which is a key part of the story's narrative about unethical business practices in the healthcare industry.

💡Emergency Room

The emergency room is a critical part of a hospital where patients with urgent medical needs are treated. In the script, it is mentioned as the location where doctors were pressured to admit patients, suggesting a misuse of the ER for financial gain rather than medical necessity.

💡Quotas

Quotas are numerical targets set for individuals or teams to achieve. In the video's context, the mention of quotas implies a system where doctors were given specific targets for patient admissions, which could lead to unethical practices to meet these targets.

💡Department Chief

The Department Chief is a senior administrative position within a hospital. The video script quotes a Department Chief stating that admitting 20% of patients was a requirement, illustrating the hierarchical pressure that may have contributed to the unethical practices.

💡Whistleblower Lawsuits

Whistleblower lawsuits are legal actions taken by individuals who expose illegal or unethical practices within an organization. The video mentions eight such lawsuits against HMA, indicating a significant legal response to the alleged wrongdoings.

💡Medicare Fraud

Medicare Fraud refers to the intentional deception to obtain payments from the Medicare program. The video script connects the unnecessary hospital admissions to Medicare fraud, suggesting that the hospital's actions were not only unethical but also potentially illegal.

💡US Department of Justice

The US Department of Justice is a federal agency responsible for enforcing the law and administering justice. The video script notes that the Department has joined the whistleblower lawsuits, indicating a high level of government involvement and the seriousness of the allegations against HMA.

💡Former Chief Executive

The former Chief Executive is the highest-ranking executive in a company, responsible for its overall management. The video identifies Gary Nome, HMA's former Chief Executive, as being behind the scheme, suggesting that the unethical practices were orchestrated at the highest level of the organization.

💡60 Minutes

60 Minutes is a long-running television news magazine show known for in-depth investigative journalism. The mention of '60 Minutes' at the end of the script signifies the source of the report and its credibility, as the show is known for thorough and impactful reporting.

💡Mormon Mission

A Mormon mission refers to a religious service assignment within the Church of Jesus Christ of Latter-day Saints. The video script mentions that Gary Nome, the former CEO, now runs a Mormon mission in Uruguay, which contrasts his current role with his past involvement in the alleged unethical practices at HMA.

Highlights

Health Management Associates (HMA), the nation's fourth-largest for-profit hospital chain, is accused of pressuring doctors to admit emergency room patients regardless of medical need.

HMA allegedly set quotas for admitting patients, with threats of job loss if targets were not met.

The US Department of Justice has joined eight whistleblower lawsuits against HMA.

The lawsuits target unnecessary hospital admissions and Medicare fraud.

Former Chief Executive Gary Nome is singled out as being behind the scheme.

Gary Nome retired last summer and is now running a Mormon mission in Uruguay.

The report suggests a systemic issue within HMA regarding patient admissions.

The involvement of the US Department of Justice indicates the severity of the allegations.

Whistleblower lawsuits highlight a culture of fear and pressure within the hospital chain.

The case raises questions about the ethics of for-profit hospitals and patient care.

The report implies potential harm to patients due to unnecessary admissions.

The former CEO's current occupation in a Mormon mission contrasts with his past role in the alleged scheme.

The story is an update on a previously reported issue, indicating ongoing interest and developments.

The report suggests a potential impact on HMA's reputation and operations.

The involvement of multiple whistleblowers indicates a widespread issue within the company.

The report raises concerns about the integrity of the healthcare system and patient safety.

The report is part of a larger investigation, as indicated by the joining of multiple lawsuits.

The report serves as a call to action for regulatory bodies to address issues within the healthcare industry.