Medicaid fraud unit to meet with Sunrise officials

Art Nadler

Friday, Oct. 2, 1998 | 11:26 a.m.

The state attorney general's Medicaid fraud unit is meeting today with Sunrise Hospital and Medical Center officials as part of an ongoing investigation into alleged billing-practice violations.

The state's Medicaid fraud unit, in conjunction with the Federal Bureau of Investigation, seized 200 boxes of documents, computer records and other documentations from the hospital, at 3186 S. Maryland Parkway, in April.

Tim Terry, chief of the Medicaid fraud unit, declined to discuss the investigation other than to say it is ongoing and has involved discussions with representatives at Sunrise and its parent company, Columbia/HCA Healthcare Corp. of Nashville, Tenn.

"This is very normal -- the conversations between (Sunrise and attorney general's) attorneys," said Ann Lynch, vice president of community services at Sunrise Hospital. "We are not anywhere at this point, except doing the legal part."

Lynch said the hospital hasn't changed its billing practices since the records were taken.

The FBI also has been conducting a nationwide investigation of Columbia/HCA's Medicare billing practices for more than two years involving its coding system. The company is suspected of "upcoding" billings to obtain maximum revenue reimbursement.

Christopher Thompson, chief health-care and financial analyst with the state Department of Human Resources, said Sunrise Hospital uses sophisticated computer programs -- based on codes -- to seek out the highest monetary returns.

The attorney general's office wouldn't say whether its Medicaid billing investigation was similar to the Medicare computer-billing probe.

The state reportedly began its investigation in May 1997 after Marc Gardner, a former Sunrise Hospital executive, told the Wall Street Journal, "I committed felonies every day."

Gardner said he arranged to have cardiac catheters sterilized and reused, the number of registered nurses on staff reduced, 15 nursing managers fired and limited care given to uninsured patients.

Mitch Mitchell, president and chief executive officer at Sunrise, has denied these charges and said Gardner was disciplined for being overly aggressive.

A judicial panel in Washington, D.C., recently consolidated five class-action lawsuits alleging that Columbia/HCA encouraged upcoding. They seek an accounting and compensation for any overpayments.

Morris Ratner, an attorney with the New York City and San Francisco law firms of Lieff, Cabraser, Heimann and Berstein, said no Las Vegas residents are named as plaintiffs in these cases. Because this is a class-action lawsuit, however, he said the outcomes would affect Sunrise patients who may have experienced billing problems.