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SLASHING THROATS FOR THE SAKE OF PROFIT
It is a story of secret recordings, bloodcurdling accusations, and exactly how far a for-profit hospital is willing to stray to grab an extra dollar. Or millions of them.
Medicare and Medicaid criminal fraud charges have been levied against Sacred Heart Hospital, a facility located in one of the poorest parts of Chicago. Allegations made in an FBI complaint include sedating patients so heavily during surgeries that they were unable to breathee on their own. This necessitated performing highly lucrative tracheotomies, a procedure where a cut is made directly into the patient’s windpipe to open up a direct breathing passage. Cost to Medicare for this one-inch incision? A cool $160,000. Not a small chunk of change for a for-profit hospital. Doctors also saw profits because they could bill $160 for each visit to a hospitalized tracheotomy patient at the hospital — versus $32 for seeing a ventilator patient in a nursing home.
The death rates following the surgery were just as startling. Five of the 28 Medicare patients who underwent the procedure died within two weeks. That ratio of deaths is three times the average for the state.
One FBI affidavit reads, “the nurse manager stated that one of the ICU nurses had advised her that Physician D had previously directed the nurse to “snow the patient,” meaning that Individual A should be heavily sedated to the point where the nurse could only see the whites of Individual A’s eyes, thereby precluding the patient from being weaned from the ventilator.” Another quotes the hospital’s owner, Edward Novak, as saying that tracheotomies are the hospital’s “biggest money maker.” The hospital’s pulmonologist, or respiratory specialist, is quoted as saying during an April conversation that Novak asked him “to provide two more tracheotomy cases for the hospital soon,” before inspectors – who had visited the hospital in March – returned.
Novak — along with his chief financial officer and five physicians — has already been charged with Medicare fraud. The criminal complaint alleges that they gave or received kickbacks in return for patient referrals. As this story develops, additional charges will surely be forthcoming. Ryan Stumphauzer, a former federal health care fraud prosecutor in Miami who reviewed the 90-page FBI affidavit was quoted as saying, “A typical indictment might allege phantom billing or improper coding. This complaint alleges the hospital and doctors were performing unnecessary invasive surgery to justify false billing.”