Part I: Shady Management; Shady Dealings—For-Profit Health Care in Key West
Martha K. Huggins, Ph.D…….
The Physicians’ Hippocratic Oath includes the sacred pledge to serve “according to my ability and judgment, prescribe a regimen for the health of the sick; …[and] utterly reject harm and mischief.” Just in case such a pledge becomes unimportant with health care’s profitability, “hospital districts” and their boards of directors sometimes become a community’s watch dog over healthcare operations. For its part, the Board of the ‘Lower Keys Hospital District’ oversees “hospitals, medical facilities, and other health care related facilities and services [that operate toward preserving ]…public health, for the public good, and for the…public of the [lower Keys] District….” The Lower Keys Hospital District Board is falling far short of its mission.
Alphabet Soup of Names and Organizations
You’ll be unable to locate in Florida’s corporate registry (Sunbiz.org), Key West’s hospital at 5900 College Road on Stock Island–dubbed the ‘Lower Keys Medical Center’(LKMC). A for-profit corporation, the LKMC hospital is registered in Sunbiz, as ‘Key West HMA’ (Fla. reg. 65-0905661). A Florida subsidiary of two linked corporations–the foreign (out of state) for-profit, ‘Health Management Associates’ (HMA) [of Delaware and Franklin, Tennessee] and Community Health Systems, Inc. (CHS), an out of state (foreign), for- profit corporation, registered in Florida (reg. 33774)—‘Key West HMA’—our hospital on college road—is being gobbled up by a Fortune 500 company—Health Management Associates (Delaware/Franklin, Tennessee). Described as the “largest provider of general hospital healthcare services in the United States,”[i] Health Management Associates (Delaware and Tennessee) is listed on the New York Stock Exchange (NYSE) as ‘CYH. Both subsidiaries of Health Management Associates–Community Health System’s Inc. (Fla. Reg. P33774) and its ‘Key West HMA’—operate as “corporation service companies.”
Outsourcing Hospital Care to Stock Market Speculation
Corporation Service Companies manage their client’s financial risks and in the process obfuscate ownership and therefore protect investors. Health Management Associates (HMA) offers its clients a range of services, including making “[corporate] filings and other transactions,” managing, monitoring, and protecting “your brands with corporate domain management,” and “serv[ing] as your registered agent.” The Stock Island-based Lower Keys Medical Center (LKMC), our hospital–is managed off-site by Tennessee-based ‘Health Management Associates’ through its Florida corporate subsidiaries, Community Health Systems, Inc. (Fla. reg. 33774) and Key West HMA, LLC (Fla. reg. 65-09056610. In fact, the hospital called, the “Lower Keys Medical Center, does not exist in our state’s corporate universe. The real name of our acute care hospital on Stock Island is, ‘Key West HMA,’ a designation that perhaps does not comfort those with health problems. Bloomberg News confirms that “Key West HMA, LLC doing business as Lower Keys Medical Center,…based in Key West, Florida….operates as a subsidiary of Health Management Associates Inc.”
The physical location of Key West HMA, LLC, according to its Sunbiz registration, is Tallassee Florida; the LLC’s mailing address in Franklin Tennessee, is also used by ‘Key West HMA’s three registered corporate agents (“Managers”). Key West HMA, LLC manages its Stock Island-based Lower Keys Medical Center hospital from Franklin, Tennessee, using local intermediaries, of course.
Calling our Lower Keys Medical Center hospital, ‘Key West HMA, LLC,’ signals the hospital’s real purpose: satisfying stock holders. It can thus be assumed that Key West HMA, LLC, manages our hospital’s “corporate compliance, governance, [and] litigation….”[ii] toward reducing losses and enhancing corporate and stock holder profits.
Over-Charging and Law Suits: Taking up with bad people
The most pathetically glaring example of profits over health is the string of lawsuits against Health Managements Associates of Delaware and Franklin Tennessee, with one recent suit filed against our own Lower Keys Health Center, under management of Key West HMA, LLC. Reporter Gwen Filosa [iii] in Florida Keys News (8/17/2016), disclosed that our “only hospital [LKMC] knowingly tried to collect more than twice it was legally owed by a patient…” Key West Tourist, Gertrude Millien, from Las Vegas, “racked up more than $17,700 in medical bills after a car crash, according to a federal lawsuit claiming a system of financial fraud” by the hospital. Gertrude Millien, “wants a judge to certify her complaint as a class-action lawsuit, claiming she is just one of an estimated 5,000 patients over-billed by the [Lower Keys Medical Center] hospital, which showed ‘wanton and reckless disregard for the rights’ of consumers.”
But this seemingly isolated Key West case is not dangling out there alone:[iv]:
- In 2010, when Community Health Systems (CHS) was managing Oregon’s McKenzie-Willamette [hospital, its] healthcare workers’ union, SEIU, Local 49, claimed that workload increases, slashed benefits, and staff reductions, had lowered the quality of both patient care and quality of life for employees. The union, in its “Profits Before Community” campaign against the hospital,…highlight[ed] that profits have tripled while charitable care and employee benefits have steadily decreased since the hospital moved from a non-profit to a for-profit enterprise under Community Health Systems.
- In 2011, [Community Health System’s client], Tenet Healthcare [was accused] of overbilling Medicare in its aggressive admissions policy compared to its peers. It was subpoenaed by Medicare on its aggressive billing to the Medicare systems.[15]
- On August 4th, 2014, Community Health Systems paid $95.14 million dollars to the United States Department of Justice to resolve multiple lawsuits “alleging that the company knowingly billed government health care programs for inpatient services that should have been billed as outpatient or observation services.”
- On February 2nd, 2015, Community Health Systems was required to pay $75 million to settle allegations “that they made illegal donations to county governments to reap more federal dollars under a now-discontinued matching program.” The allegations were brought about by a former CHS employee in a complaint under the False Claims Act.
- In October 2015, Community Health Systems paid $13 million to the United States Department of Justice to resolve allegations related to the False Claims Act.
An apparent recidivist law breaker, Tennessee-based Community Health Systems (CHS) and its lower keys affiliate Key West HMA, LLC, need close monitoring by the Lower Keys Hospital District. However, as I will show next week, the possible complicity between Key West’s hospital system board and the even more complicated corporate outsourcing of our LKMC hospital will make such monitoring difficult, but not impossible.
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[i] WIKI https://en.wikipedia.org/wiki/Community_Health_Systems
[ii] Ibid
https://www.cscglobal.com/service/cls/representation-compliance
[iii] http://www.flkeysnews.com/news/local/article96130857.html
[iv] https://en.wikipedia.org/wiki/Community_Health_Systems
I have full SSDI Medicaid and they have billed over $2,000,000 for me. Let me know when you want to fact check that billing and see if they cheated Medicaid.
Despite that business I have provided them, if I go out there and get a coffee and sit in the Tropical Cafe these for profit assholes will have security run me off to stand outside in the heat with medical disability to wait. Now if they think I’m out there for anything they can bill, the red carpet rolls out. The emergency section is far better run than the rest of it. And I’ve had many 30 and 14 day stays out there. Dr. Atilla is particularly horrible. He needs to be run off for the crap he pulls…
The continuing shift in our community to “boutique” doctoring flies in the face of everthing I have known about healthcare in this country in my 72 year lifetime. Bah humbug!!
Wow! What good research ! Can anyone recall when and by whom this deal was approved? Was it by the County or City or just some board? Was anyone paid off or did they just not do the research? Pretty damning info.
Excellent research on the veil of corporate structures, Martha. These structures exist to do the opposite of providing good health care; rather, they exist to provide profits while protecting their executives from personal accountability.
Capitalism has changed greatly in our lifetimes. Milton Friedman in 1970 declared that the only responsibility of a business is to “increase its profits.” The corporate world took this to heart, and the result is the Epipen, Wells Fargo making false accounts, liar’s loans, off-shoring, union busting, corporate tax inversions, middle class wage stagnation, a trillion in student loans to for profit colleges, all for the benefit of the profit-making top 1%.
By Florida statutory law, we are required to have a non-profit hospital. The more we privatize health care, the military, and prisons, the worse the outcomes. For-profit health care cannot be fixed. We must take back our hospital.
Dear Rick,
Allow me to commend both you and Dr. Huggins for your very meticulous, forthright recounting of history. I can only say that if you could articulate your findings in more abbreviated form, it would be to the advantage of your point.
Now, let’s address your points:
– The only responsibility of business is to “increase its profits”.
A: That has been understood since the beginning of time. 😉
– EpiPen, Wells Fargo, DB, et al…are examples of how these corporations have broken (or, at least bent) the laws in place.
A: That’s why they’re being pursued…and penalized.
– For-profit health care cannot be fixed…we must take back our hospital.
A: For-profit health care is fine. Besides…in your judgement, just who/what would adequately supplant the current structure at LKMC?
Does Key West really need to revisit this nightmare?
Dickford
THANK YOU MARTHA! If anyone can peel back the layers of this horrible hospital mess – it’s you!
This story keeps getting uglier the more we learn. Those behind the curtain seem to get more desperate by the day, now asking for the case filled on behalf of Key West Tourist, Gertrude Millien, from Las Vegas to be dismissed, and let’s not forget the Hospital Board recently decided to seek an independent legal opinion – but when Chairman Levine pulls the strings and selects the “independent” attorney can we guess what that outcome will be?! The wolves not only guard the hen-house but are now circling the wagons.
Can’t wait for your follow-up story Martha.
The public won’t be fooled. We continue to stand together and will not back down – not until we get OUR hospital back.
Dr Huggins, Thank you so much for pointing out the disgusting behavior of our for profit disease maintenance system. People entering LKMC are not patients,but rubes to be bilked and as Rick noted it has become much worse. Screwing people out of money is the new normal…Greed and corruption have been sanctioned by the Supreme Court of the United States, for God’s sake! Criminal Corporate Capitalism is a cancerous disease in itself and it’s metastasizing rapidly.
Single payer, not for profit is the only answer. No middle man. No redundant parasitic, pointless third party with shareholders is needed for an efficient and economically smart healthcare system.
I look forward to more from you on this!