More hospitals are coming under the federal investigatory microscope for alleged cases of patient dumping-thanks in large part to competing hospitals ratting on them.
Consider an incident in Phoenix that was recently settled with HHS' inspector general's office.
After a suspected patient dumping incident at Phoenix Regional Medical Center on Aug. 10, 1996, not-for-profit Good Samaritan Regional Medical Center called HCFA and reported on its neighbor, a for-profit owned by Columbia/HCA Healthcare Corp. of Nashville.
Good Samaritan was following a relatively new HCFA regulation that requires hospitals to report suspected incidents of patient dumping.
A 1986 federal law prohibits patient dumping, or denying basic medical screenings to patients because they lack the ability to pay. The law also prohibits transferring medically unstable patients for economic reasons.
The reporting regulation, which took effect in 1995, was developed to give hospitals a greater incentive to follow the law, said Ken Simpson, health program evaluation officer for HCFA's regional office in San Francisco.
"(The reporting requirement) was put in there as a stick," Simpson said. "It's to put pressure on hospitals to not send someone away inappropriately. It's a very punitive measure."
The reporting regulation has led to a tsunami of tips from hospitals that receive patients from other facilities, Simpson said.
Before the regulation took effect in 1995, Simpson's office received six or seven reports a year. That number has skyrocketed to 50 to 60 reports a year, he said.
"Certainly the reporting requirement has increased the number of complaints that have come into our office," Simpson said. "Speaking for the West, we've seen a dramatic growth in the number of complaints, mostly from hospitals."
Following the regulation, however, can strain hospital relationships in a market.
"In the community of hospitals, it's a difficult regulation," said Bill Byron, a spokesman for Good Samaritan in Phoenix. "It puts institutions in an uncomfortable position. It's unfortunate . . . that you're placed in the role of policeman."
Byron said hospitals that report their competitors have little choice in the matter. If a hospital doesn't report an incident, it could face the same punishment as the hospital that allegedly dumped the patient-a maximum civil monetary penalty of $50,000 per violation and possible exclusion from the Medicare program.
"We don't feel good or bad about (reporting Phoenix Regional)," Byron said. "We were following regulations, and it's pretty objective what you have to do."
Denny Powell, chief executive officer at Phoenix Regional, said most hospital administrators would prefer that their colleagues pick up the phone and talk to them about such incidents before going to the feds.
Good Samaritan, however, called federal authorities first. But Powell said he couldn't argue with the way Good Samaritan handled the situation.
"Under the circumstances of how this was presented to them, they followed the law," Powell said. "The risk (of losing your Medicare license for violating the regulation) is too great."
In March, Phoenix Regional agreed to pay $30,000 to settle the patient-dumping allegations.
Steven Galasky, M.D., the physician on duty in Phoenix Regional's emergency room during the Aug. 10 incident, said he has received a letter demanding that he pay between $30,000 and $50,000 in fines stemming from the incident. Galasky says he will fight paying the fine "to the bitter end."
HCFA alleged that Galasky and Phoenix Regional turned away a psychiatric patient without first providing a basic medical screening to determine whether the patient was in stable condition.
Galasky told MODERN HEALTHCARE that he had arranged for the patient, who was insured through Arizona's Medicaid program, to receive care at John C. Lincoln Hospital, where the patient had been treated earlier that day.
"That's where all his (medical) records were, and when I talked to (the insurer), I was told the patient was stable," Galasky said.
Instead, he said, the ambulance service brought him to the nearest hospital, Phoenix Regional.
Galasky argued with the ambulance personnel, who subsequently took the patient to Good Samaritan, about two miles away. He said he did not tell them to take the patient to Good Samaritan.
HCFA's Simpson acknowledges that there is some potential for hospitals to abuse the reporting requirement, such as turning in competitors for minor or questionable infractions.
"By and large, they're legitimate issues," he said. "We haven't gotten too many reports where there wasn't something behind it."
However, some hospitals are reporting "every little thing," including minor mistakes on paperwork, said Todd Taylor, M.D., vice president of the Arizona chapter of the American College of Emergency Physicians. It's causing some animosity among hospitals, he said.
"(The reporting) is out of control. It gets really childish sometimes," said Taylor, who also is on staff at Good Samaritan, the hospital that reported Phoenix Regional. "I think it's un-American for us to have to report our colleagues."
However, there is no evidence that the Phoenix case was inspired by such ill will, executives at both hospitals said.
"I would hope that institutions in hyper-competitive markets wouldn't resort to that," Byron said.