(Reuters) - U.S. authorities are investigating billing practices and whether heart procedures performed at HCA Holdings Inc hospitals were medically necessary, the company revealed in a regulatory filing on Monday, sending its shares down seven percent.
HCA, in an unusual move, also issued a detailed rebuttal defending itself against a not-yet-published report by The New York Times. The company said it believes the newspaper will question physician decisions at its hospitals regarding certain heart procedures.
The U.S. Department of Justice is reviewing whether charges to the federal government related to use of implantable cardio-defibrillators (ICDs) met with billing criteria set by the Medicare health program for the elderly, HCA said in a filing with the U.S. Securities and Exchange Commission. The review will include ICD billing and medical records at 95 of the company's 163 hospitals from October 2003 to the present.
ICDs are devices implanted in a patient's chest to help regulate heart rhythm and protect against potentially dangerous racing heart beats. Major manufacturers of the devices include Medtronic Inc, Boston Scientific Corp and St Jude Medical Inc.
HCA also said that in July the federal prosecutor's office in Miami requested information on reviews assessing the medical necessity of certain interventional heart procedures. HCA said it believes such reviews have taken place at about 10 of its hospitals, primarily in Florida. The company said its own review of how many of its hospitals may be affected was not yet complete.
Interventional heart procedures include angioplasty and stenting used to clear and prop open blocked coronary arteries.
News of the federal probes comes as hospital operators are set to see higher admissions of insured customers as a result of President Barack Obama's healthcare reform law that was recently upheld by the Supreme Court.
At the same time, pressure is growing on the U.S. healthcare system to find ways to rein in costs that have contributed to a massive national deficit. Recent studies have questioned the potential overuse of highly profitable interventional heart procedures in the United States, such as stenting and the placing of ICDs.
HCA said The New York Times may publish one or more articles about the company in which the newspaper will address patient care provided at HCA hospitals.
Based on questions posed by the Times, HCA said the reports may address how decisions are made regarding the medical necessity to perform certain heart procedures, such as cardiac catheterizations and artery clearing angioplasty, and the volume of such medical actions.
The New York Times declined to comment on stories that it has not published.