Hospital management companies sued for Medicare billing schemes at five rural Oklahoma hospitals

Two hospital-management companies have been sued for allegedly fraudulent billing schemes run through five rural Oklahoma hospitals. Small rural hospitals are tempting targets for health-care companies looking to make extra money. It works like this: Medicare and some insurers reimburse hospitals for laboratory services at higher rates to help them stay open, so a company might buy a struggling rural hospital or sign up to manage it for a fee, and issue bills for laboratory services through that hospital, even if the lab services were done elsewhere.

Insurance giant Aetna has filed suit against People's Choice Hospitals, a management company that in May 2016 bought Newman Memorial Hospital in Shattuck, Okla. The hospital believed it had been tricked into an illegal billing scheme and sued People's Choice; the case was settled out of court. Aetna's lawsuit alleges fraud that it says cost it millions, Meg Wingerter reports for The Oklahoman.

Health Acquisition Co. is involved in several different lawsuits stemming from its billing practices at four hospitals it had a controlling interest in: Drumright Regional Hospital, Fairfax Community Hospital, Prague Community Hospital, and Haskell County Community Hospital. All four left Blue Cross Blue Shield of Oklahoma's provider network in February after the insurance company objected to their billing practices, Wingerter reports in a different article for The Oklahoman. 

One lawsuit names Empower HMS, a management company that shares ownership with HAC; lawsuits in other Florida and Missouri accuse Empower HMS owner Jorge Perez of fraud and other illegal conduct because of billing schemes. Perez has a stake in HAC and was once an executive in People's Choice, Wingerter reports.