HCA International - the international arm of HCA [Hospital Corporation America]

1968 in Nashville, Tennessee, USA by Dr. Thomas Frist, Jr., Jack C. Massey and Dr. Thomas Frist, Sr. (1)

HCA is the USA’s leading provider of healthcare services, a company comprised of 163 hospitals and 110 freestanding surgery centres in 20 US states and the UK and employing approximately 199,000 people. Approximately 4-5% of all inpatient care delivered in the USA is provided by HCA facilities. (1)

HCA International operates six hospitals in central London: The Harley Street Clinic, The Lister Hospital, London Bridge Hospital, The Portland Hospital, The Princess Grace Hospital, and The Wellington Hospital. HCA International also has a range of outpatient and diagnostic centres, including 30 Devonshire Street, 31 Old Broad Street, the Brentwood Medical Centre in Essex, the Sevenoaks Medical Centre in Kent, the Chelsea Consulting Rooms, Chelsea Outpatient Centre, the City Of London Medical Centre, Docklands Healthcare, the Platinum Medical Centre in St John's Wood in North London. (2)

HCA has four joint ventures with NHS hospitals: a blood and bone cancer treatment centre with the University College Hospital London; a young person's cancer unit, The London Gamma Knife Centre, at St Bartholomew's Hospital in The City of London; Harley Street at Queen's, a private patient cancer centre at the Queen's University Hospital in Romford; and with the Christie cancer hospital in Manchester, The Christie Clinic, a private patient unit for cancer patients from across the North of England. (3)

HCA International’s primary source of income is the corporate market and international clients. HCA has not sought contracts with PCTs, but its strategy with the NHS has been to set up joint ventures through its HCA NHS Ventures business. The company has four partnerships at present. It is a member of the Private Hospitals Alliance, who collectively share 80% of the UKs private hospitals, a group formed to influence the Government’s healthcare policy. (2)

The most recent accounts available from Companies House for HCA International are for the financial year ending 31 December 2011. (7)

 

In 2006, Kohlberg Kravis Roberts and Bain Capital Partners, together with Merrill Lynch and the Frist family (which had founded the company) completed a $31.6 billion acquisition of HCA. Then in March 2011, HCA raised $3.8 billion in what was at the time the US’s largest private-equity backed initial public offering (IPO). Following the IPO the three private equity companies and the Frist family continued to own a majority share of HCA (62% in December 2011). (8) Bain Capital Partners was founded by Mitt Romney, the Republican nominee for the 2012 US presidential election. Bain Capital has a notorious reputation for buying companies then using profits to pay dividends rather than investing in the company leading to previously financially stable companies becoming financially unstable. The company has also been investigated for its tax evasion strategies. (19)

HCA International does not have contracts with PCTs, but works with the NHS on joint ventures through its HCA NHS Ventures business. (3)

In 2010 HCA International donated £8,500 to the Conservative Party. (9) HCA International is part of the Private Hospitals Alliance (formerly H5) which lobbies Westminster on issues regarding healthcare and the role of private companies in delivering NHS services. In 2013 an investigation by The Mirror discovered that HCA had given the Tories at least £17,000 since they came to power. This was amidst news that HCA had been awarded a multi-million pound contract to treat NHS patients with brain tumours.

Fraud and malpractice in the USA

The major concerns with HCA International revolve around the behaviour of its parent company in the USA, which has been found guilty of large-scale fraud in recent years, and is at present the subject of an extensive investigation by the US Department of Justice into the company’s practices. The parent company, HCA, was the subject of one of the US’s longest running investigations into fraud in the healthcare industry. The investigation began in 1993; by June 2003, following two settlements, one in 2000 and one in 2002, HCA had paid the US government a total of over $2 billion in criminal fines and civil penalties for systematically defrauding federal health care programs. HCA was found to have unlawfully charged the government in its cost reports for running its hospitals, that it paid kickbacks (incentives) to doctors in return for Medicare and Medicaid referrals, and that it unlawfully charged the government for costs in connection with wound care facilities. Despite the severity of the crimes, no senior executives went to prison, although a few mid-level executives were found guilty of fraud. (10, 11, 12, 13, 14, 15,16) More recently a scandal has erupted in the USA concerning unnecessary cardiac procedures being carried out on patients at HCA hospitals. In August 2012 The NY Times published articles based on an extensive investigation it had conducted into cardiac procedures carried out at HCA hospitals, primarily in Florida, but also in some other states. The NY Times reviewed thousands of pages of confidential memos, e-mail correspondence among executives, transcripts from hearings and reports from outside consultants, as well as interviews with doctors and others. The NY Times concluded that “a review of those communications reveals that rather than asking whether patients had been harmed or whether regulators needed to be contacted, hospital officials asked for information on how the physicians’ activities affected the hospitals’ bottom line.” The NY Times also notes that “the documents [reviewed] suggest that the problems at HCA went beyond a rogue doctor or two.” Concern over unnecessary cardiac procedures surfaced in 2003, again in 2004, and once again in 2008. HCA had carried out its own reviews, but had not always revealed the findings. In August 2012 HCA had to reveal to investors that the US Department of Justice is conducting an investigation into whether heart procedures performed at HCA hospitals were medically necessary and also the company's billing practices. The investigation will cover the period October 2003 to the present. A NY Times article notes that HCA has declined to provide evidence that it had alerted Medicare, state Medicaid or private insurers of its findings, or reimbursed them for any of the procedures that the company later deemed unnecessary, as required by law. Furthermore, HCA also declined to show that it had ever notified patients, who might have been entitled to compensation from the hospital for any harm. (17,18)

1. http://hcahealthcare.com/about/
2. http://www.hcahospitals.co.uk/about-hca/key-facts-and-figures/
3. http://www.hcahospitals.co.uk/about-hca/nhs-ventures/
4. http://phx.corporate-ir.net/phoenix.zhtml?c=63489&p=irolnewsArticle&ID=1656741&highlight=
5. http://www.hcahospitals.co.uk/about-hca/management-team/
6. http://phx.corporate-ir.net/phoenix.zhtml?c=63489&p=irol-governance
7. Accounts for HCA International for 2011 obtained from Companies House January 2013
8. http://www.ft.com/cms/s/0/2ffca8fe-4a9b-11e0-82ab-00144feab49a.html#axzz2BdJHOfbJ
9. https://pefonline.electoralcommission.org.uk/search/searchintro.aspx
10. http://www.nytimes.com/1997/07/26/business/2-leaders-are-outat- health-giant-as-inquiry-goes-on.html

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