This story can't be repeated enough. The $1.7 billion in fines HCA/Columbia paid to settle Medicare/Medicaid fraud allegations is directly related to Rick Scott losing his job as CEO of the HCA/Columbia hospital chain.
According to Rick Scott, he wanted to fight the charges, but the HCA Board, chose to settle.
According to Rick Scott, there was more smoke than fire in the fraud allegations.
According to Rick Scott HCA/Columbia is behind him... a one time issue.
Rick Scott says he learned valuable lessons about leadership and how to require accountability from his employees.
Rick Scott implies that the health care fraud that occurred under his leadership wouldn't happen today, because his HCA experience makes him a better CEO.
That would be a fairy tale. Rick Scott's new company, Solantic is associated with insurance abuse and fraud too. The case has been referred to HHS for investigation.
Rick Scott didn't learn how to prevent a corporate culture of greed - he's perfected it.
Yet, for some reason, Rick Scott is still in the running for Florida governor. If he wins, he'll be able to help his friends to the Medicaid cookie jar.
What are Florida voters thinking?
Why would anyone think an ethically challenged health care executive would make for a good governor? The polls show a very weak lead for Alex Sink or it being a toss up and I don't understand it. Florida's conservative voters should like Alex Sink, she's barely a Democrat. Sink's tenure with Bank of America ended in 2000, long before when the mortgage bubble burst and long before derivatives and CDO's. Furthermore, Sink was President of Florida Operations for BoA, not the CEO of BoA - a huge difference. She wasn't making loan decisions, she wasn't authorizing transactions; she was overseeing recording the transactions. Alex Sink's work history shows detail oriented organizational skills.
So, why does Rick Scott have so many friends? You would think that looking into his work history would be enough for voters to take a pass on Rick Scott as too risky. Too likely to continue his unethical behavior as Florida's Governor. Do people really not understand the implications of Rick Scott's behavior and management style? Are people really that unaware of what Rick Scott could do if he became Florida's Governor?
Rick Scott: HCA/Columbia
The HCA/Columbia fraud case came down to 2 accountants at 2 different hospitals blowing the whistle for the same problem. They were instructed to keep 2 sets of books for Medicare, one set more aggressive than the other. The accountants didn't like the ethics of that directive. They received $100 million as the finder's fee for identifying the fraud. There were over 30 HCA whistleblowers, but the 2 accountants brought the hammer down.
The FBI investigated and found enough evidence in the various HCA/Columbia hospitals to force the $1.7 billion dollar settlement which breaks down includes:
— $403 million for upcoding. False diagnosis codes were assigned to patient records to elevate the DRG (aka DRG creep) which would increase reimbursement to the hospitals under Medicare. False diagnosis codes also increased reimbursements under the Medicaid, TRICARE (military) and the Federal Employees’ Health Benefits Programs.
— $356 million for systemic plans to defraud Medicare, Medicaid and TRICARE through hospital cost reports. These are submitted at year-end by hospitals to the government to reconcile payments received during the year with amounts hospitals claim are actually owed. HCA/Columbia billed temp agency expenses as their expenses.
— $225.5 million for unlawfully billing Medicare, Medicaid and TRICARE for claims generated by illegal payments to physicians for referring patients. Rick Scott signed off on several HCA/Columbia Annual Reports that specifically warned that compensating physicians in this manner could be construed as a kickback violation.
— $106 million for billing Medicare, Medicaid and TRICARE for home health visits for patients who did not qualify to receive them or for visits that were not performed, and for committing other billing violations.
— $95 million for billing to Medicare, Medicaid, TRICARE and the Federal Employees’ Health Benefits Program for lab tests that were not medically necessary or were not ordered by physicians, plus other billing violations.
— $90 million for illegally charging Medicare for non-reimbursable costs in the purchase of home health agencies owned by Olsten Corp.
— $50 million for illegally claiming non-reimbursable marketing and advertising costs disguised as community education.
— $5 million because HCA’s Lawnwood Regional Medical Center in Fort Pierce submitted false claims in Medicare cost reports by inflating treatment for indigent patients and by shifting employee salary costs to boost its reimbursement.
Ok, so the $1.7 BILLION was a settlement and an agreement to plead GUILTY for Medicare, Medicaid, Tricare and FEHB fraud, illegal kickbacks, billing for medically unnecessary treatment, billing for non-reimbursable costs and manipulating accounting practices to inflate insurance reimbursements. ...and Rick Scott wants us to believe he didn't know what was going on?
Rick Scott, a lawyer, apparently didn't read the health care laws that have a new standard. Many health care laws have a clause that make employees responsible for fraud, waste and abuse if they knew or should have known about the violations. Rick Scott as CEO of HCA/Columbia should have known about the fraud, waste and abuse and since he signed off on the Annual Reports that said the compensation plans with physicians could be construed as illegal; it's hard to believe he didn't know his company was neck deep in wrong doing.
Rick Scott: Solantic
HCA/Columbia was not an isolated case. Rick Scott left the hospital chain and opened a chain of urgent care centers in Florida, Solantic. It has several former HCA/Columbia employees on their management team and a similar corporate culture to what Scott presided over when he was at HCA/Columbia. Last August a leaked email from Dr. Prokes kicked up a good bit of dust, but Bill McCollum still lost the GOP primary for governor - it seems as if the Florida GOP has no problem with electing or appointing people with shady pasts.
There are 2 physicians, Dr. Randy Prokes and Dr. Mark Glencross (who don't know each other and didn't work together) currently claim that Solantic charged insurance companies for services they didn't provide. Prokes makes allegations that nurse practitioner patient encounters were billed as physician encounters to Medicare (serious no no) under his name. Glencross settled his case and the records are sealed. Scott refuses to release his deposition in the case. There's a third doctor who quit after 2 months due to pressure to order unnecessary procedures, pharmaceuticals and services. AHCA decided there wasn't anything to pursue under the Medicaid program, so they referred the case to HHS to investigate possible Medicare issues.
So, Rick Scott presides over another health care company that has improper billing procedures. Rick Scott's company allegedly bills for services the physicians weren't present to provide. Another Rick Scott company that allegedly encourages unnecessary medical procedures and care. A company that has settled improper billing lawsuits with physicians that feature non-disclosure agreements that hamper independent investigation into these claims. Do we need to wait for another settlement between another Rick Scott company and the federal government?
The problem with determining what Rick Scott knew or should have known about the health care fraud occurring at his companies is that Rick Scott is well versed in obfuscation. Alex Sink's attack ads aren't well parsed out and merge Scott's behavior at HCA/Columbia with Solantic. Although both companies are associated with health care fraud and abuse, the attack ads don't separate the deposition due to Solantic from the guilty plea made after Scott's ouster at HCA/Columbia. The fact that both companies are associated with the same types of illegal activity is lost on Scott's defenders. Also, lost on Scott supporters is:
Rick Scott and the Dropped Insider Trading Charge
Rick Scott was able to get the insider trading charge dismissed against him during the HCA/Columbia case in back and forth rulings between lower and appellate courts. The Pension Fund lost it's case, but I'm sure the Pensioners are still paying for it.
According to the suits, Scott owned 9.4 million shares of Columbia/HCA. He had sold 128,000 shares from 1995 to 1997, including 90,000 on a single day in February 1995. That $2.65 million payday was flagged by plaintiffs, who noted the sale came 23 days before federal agents raided Columbia/HCA offices as part of a long-term investigation.
Did company officials know ahead of time that the chain was headed for trouble?
A week after the hospital office raids, the New York Times published a "special report" detailing Medicare and Medicaid violations after a yearlong examination of more than 30 billion company billing records.
The newspaper wrote that its reporters did not give the company an opportunity to review its data, but had provided company officials with its findings over a period of several months.
There is no reason for Rick Scott to be seriously considered a viable candidate for Florida Governor. It is mind boggling that here we are less than 3 weeks away from the election and he's as high as he is in the polls. He would bring a cut throat, ethics are optional, corporate culture to Florida's State government. Florida doesn't need a Governor like Rick Scott.