By Glenn Singer, South Florida Sun-Sentinel Knight Ridder/Tribune Business News
Mar. 20--Sunrise-based Vista Healthplan said Wednesday it has severed managed care contracts with all 10 HCA Inc. hospitals in South Florida and sued the mammoth hospital chain for fraud, over-billing, errors in charges and limiting access to auditing patient accounts.
'This was not an easy decision for us to make,' said Joe Berding, the Vista chief executive officer. 'We had been talking to HCA for two years about these problems without any resolution. Terminating the contracts was in the best interest of our members who want to see lower costs.'
The HCA director of media relations, Jeff Prescott, called Vista's decision to cancel contracts 'befuddling, especially since we just signed a bunch of them in the last few months.'
The lawsuit, he said, 'is all over the place with every possible accusation, and it seems like an act of desperation.'
Vista's termination of contracts is effective April 16, and means that 293,000 members in South Florida either will have reduced coverage or no coverage if they are treated for non-emergencies at an HCA hospital.
Health maintenance organization (HMO) plan members, whose plans do not include coverage for hospitals outside the network, could be responsible for the entire bill. For preferred provider organization (PPO) and point of service (POS) plan members, co-insurance, co-payments and deductibles will apply, Vista said.
Under law, all hospitals must treat emergency cases, so Vista members still will be able to go to HCA medical centers and receive treatment for sudden or serious conditions that require immediate care. Pregnant women who give birth at an HCA hospital, even after April 16, will be covered, as well, Vista said.
The severing of contracts affects Vista's relationship hospitals in all three South Florida counties. They are: Northwest Medical Center in Margate; Plantation General Hospital and Westside Regional Medical Center in Plantation, and University Hospital and Medical Center in Tamarac.
Also included are: JFK Medical Center in Atlantis; Columbia Hospital in West Palm Beach; Palms West Hospital in Loxahatchee; Aventura Hospital and Medical Center; Cedars Medical Center in Miami, and Kendall Regional Medical Center.
Vista's Berding said late Wednesday he learned that Westside Regional had cancelled four surgeries for Vista patients scheduled for today, Friday and next week. A Westside Regional spokeswoman could not determine if that was correct.
'We had hoped the hospitals would perform surgery through the termination date,' Berding said, adding that company lawyers will seek an emergency hearing this morning in Broward County Circuit Court to stop the cancellations.
Vista's lawsuit against HCA, Berding said, resulted in part from audits of the hospital firm's bills that showed 75 percent were incorrect and resulted in overcharges 'including charges for services never provided to the patient.' Vista, in a news release, estimated the purported overcharges to be as much as $6.4 million over the last two years. HCA's Prescott had no comment on the allegations.
To see more of the South Florida Sun-Sentinel -- including its homes, jobs, cars and other classified listings -- or to subscribe to the newspaper, go to http://www.sun-sentinel.com.
(c) 2003, South Florida Sun-Sentinel. Distributed by Knight Ridder/Tribune Business News.
HCA,
