Do Hospital Systems Commit Medicare Fraud When They Set Patient Admission Goals?

Recently, 60 Minutes ran a segment looking into the questionable inpatient admission practices of hospitals owned by Health Management Associates (HMA). According to 60 Minutes, HMA is under federal investigation for pressuring its associated physicians into admitting patients, regardless of medical necessity. For added pressure, HMA supposedly set lofty patient admission goals for each hospital. Moreover, when some providers and senior-level employees raised health care fraud concerns, they were allegedly alienated, isolated and terminated by the company.

Hospital systems potentially commit Medicare fraud when they set high patient admission goals for their hospitals. Indeed, when hospitals admit Medicare beneficiaries based on monetary greed, as opposed to medical need, the admissions run afoul of the law, triggering liability under the federal False Claims Act.

More information for whistleblowers is located at the Nolan Auerbach website.