Hospitals Claim Surge in Heart Failures When Medicare Reimbursements For Them Rise

Every Chicago medical malpractice attorney at our firm knows that it is just as much evidence of mistreatment to fail to provide the hospital care a patient needs as to have the patient undergo procedures that they do not need. In both cases patients suffer physically, emotionally, and financially in needless ways because their care providers failed to act reasonably. When either form of error occurs in our state it is likely a form of Illinois medical malpractice.

Many community members fail to consider that hospitals and doctors may have incentives to provide more treatment than necessary. However, evidence exists in many contexts that doctors and hospitals, either consciously or unconsciously, make diagnosis decisions in part on the amount of money that they will be receiving for the work needed to treat the problem that they diagnose. For example, the SF Gate reported this week on disturbing new information that starkly shows that certain hospitals may be claiming that many more people than necessary have acute heart failure based on the rising financial benefit that treating these patients has for the hospital.

For example, an analysis of Medicare claims made by the one hospital from2008 to 2010 found that a staggering 35.2 percent of Medicare patients were claimed to have been suffering from acute heart failure. This claimed condition is not insignificant but instead represents a potentially fatal break down in the organ’s ability to pump blood throughout the body. It often requires costly, serious, dangerous treatments, and a diagnosis comes with untold anxiety for those receiving the news.

Experts believe that the surge in heart failure rates has conveniently coincided with changes in Medicare rules that authorize bonus payments when a hospital needs to treat patient with certain complications. The heart failure diagnosis is usually an “add-on” to another condition, bumping up the money that the hospital receives for treatment. For example, a medical patient who needs a defibrillator will usually allow the hospital to receive $30,000 in funds. However, that reimbursement rises to $52,000 (in increase in $22,000) if the patient also has acute heart failure. These bonuses only recently took effect. The hospital referred to above went from treating not a single patient for acute heart failure in 2006, to 2,000 such patients the following year. There has yet to be any logical reason given why this enormous jump would have occurred other than a very troubling attempt to make the hospital more money. Medical experts across the board have explained that the rates of many of these hospitals are grossly high-as a rate of 5-6% would be a normal.

A Chicago medical malpractice attorney would be shocked to learn of similar rates of diagnosis in area facilities. However, there is very much a chance that such misconduct could be occurring in our area. These forms of medical malpractice are harder to notice and most patients will never be told that they were victimized. It remains unclear whether this problem is based on false diagnosis, “upcoding,” or both. Upcoding refers to exaggerated billings to Medicare, a form a fraud that the federal agency takes very seriously.

See Our Related Blog Posts:

Criminal Prosecutions for Medical Malpractice on the Rise

Dangerous Illinois Doctors Stripped of Licenses

Lawyer Monthly - Legal Awards Winner
The National Trial Lawyers
Elder Care Matters Alliance
American Association for Justice
Fellow Litigation Counsel of America
Super Lawyers