"For-profit chains now own 15 percent of American hospitals. They say they are transforming a bureaucratic industry into an efficient provider of better quality care. But the expanding federal investigation of $20-billion hospital giant Columbia/HCA raises concerns that the pursuit of profits is leading to fraud and poor care.
In the most outrageous case, in 1993, the government accused National Medical Enterprises of paying "bounty hunters" to obtain patients for its psychiatric hospitals. Its doctors then gave wrong diagnoses to increase billings and held patients as young as 8 against their will until their insurance ran out. NME pleaded guilty and paid $379 million in penalties. Last month, under its new name, Tenet Healthcare Corp., it paid over $100 million to settle patient claims. Yet, Tenet is now the nation's second-largest chain.
Medicine never used to be like this. For a long time, insurers gave doctors carte blanche to run up charges. Some did. But the dominant professional ethic to do right by patients kept most from exploiting the system. For-profit hospitals have no ethic beyond making a buck. Their doctors are imbibing that spirit. That's what worries me."