No hospital is off limits to federal investigators who are looking for billing fraud.
Last month, for example, Truman Medical Center in Kansas City, Mo., was accused of billing fraud, marking the fourth time the government has targeted a hospital with a well-known executive active in a national trade association.
Although nothing connects the association leaders to the alleged fraud, legal analysts said these incidents send a clear signal to healthcare executives and boards.
"I think that the message of these cases is that no one gets out unscathed," said Alice Gosfield, a healthcare fraud attorney at Gosfield and Associates in Philadelphia.
Government officials balked at any suggestion that hospitals tied to association leaders get special scrutiny. "Absolutely not," John Bentivoglio, special counsel for healthcare fraud at the U.S. Justice Department, said through a spokeswoman.
The same is true for HHS' inspector general's office.
"We're like the New York Times: We operate without fear or favor," said Alwyn Cassil, a spokeswoman for the inspector general's office.
In the most recent case, the Justice Department filed a civil Medicaid fraud lawsuit last month against 309-bed Truman Medical Center (May 31, p. 10). The government charged the hospital and its 115-physician faculty practice plan with overbilling the state's Medicaid program for care for indigent pregnant women. The alleged billing scheme began in 1993.
E. Ratcliffe "Andy" Anderson Jr., M.D., was executive director at Truman from 1996 to 1998. Anderson is executive vice president at the American Medical Association, which has criticized the government's fraud-fighting efforts as overzealous.
At Truman, Anderson replaced James Mongan, M.D., who headed the hospital from 1981 to 1996. Mongan is president at Massachusetts General Hospital in Boston. Before his tenure at Truman, Mongan served during the Carter administration as assistant surgeon general and as a White House healthcare aide.
A month before the government sued Truman, Anne Arundel Medical Center in Annapolis, Md., paid $2.1 million to settle charges that it submitted false bills to federal health programs from 1993 to 1996 for infusion therapy patients (May 17, p. 18).
Anne Arundel has ties to Jonathan Lord, M.D., chief operating officer at the American Hospital Association. Lord was executive vice president at the Anne Arundel Health System from 1994 to 1995 and was senior vice president of medical affairs at the hospital from 1989 to 1992.
Lord declined to comment for this story.
However Richard Wade, the AHA's senior adviser for communications, dismissed any idea that the government would target association leaders' hospitals.
"Any notion they are targeting people would be repugnant, and if that were the case, that would throw their whole fraud and abuse initiatives into serious question," Wade said.
Like the AMA, the AHA has been a sharp critic of the government's crackdown on alleged Medicare billing fraud by hospitals. Most recently, the AHA has pointed to an FBI raid on a small Tennessee hospital as an example of overaggressive investigative tactics (May 24, p. 3).
Meanwhile, the hospitals of another AHA official have been hit twice by federal fraud fighters.
In 1997, the Crozer-Keystone Health System in Springfield, Pa., paid a $664,500 fine to settle charges that one of its five hospitals overbilled Medicare for certain cases of pneumonia. And in 1998, Crozer-Chester Medical Center in Upland, Pa., paid $415,044 to settle charges that it billed Medicare for lung surgery not covered by Medicare (April 19, p. 30).
The president and chief executive officer at Crozer-Keystone is John McMeekin, a member of the AHA board and a finalist last year for the AHA board chairmanship. McMeekin has thrown his name into the race again this year. He was not available for comment.
Although all sides say the cases are coincidences, the government does reap some benefit when a well-known hospital or one connected to industry leaders goes down.
"That kind of thing will likely increase visibility," said Neil Caesar, president at the Health Law Center, a Greenville, S.C., law firm specializing in healthcare fraud cases. "Consequently, if their case is weak, they will be more cautious; if their case is strong, they will embrace the added publicity that comes from the particular parties in the loop."