Political Cortex: Brain Food for the Body Politic

Founded by Frist's father and brother in the 1960s, HCA became America's largest for-profit hospital chain after merging with Columbia Healthcare in 1994.  Bill Frist didn't work for HCA but did own HCA stock worth millions before dumping it earlier this year.  He also received dividends from HCA exceeding $250,000 from 1998-2002, giving him a personal stake in the family business's bottom line.

HCA excelled at setting records.  In the `90s, the company came under the largest healthcare-fraud investigation in Justice Department history.  It lasted years and involved FBI raids on HCA hospitals.

To make multiple cases go away, HCA agreed to pay the largest healthcare-fraud settlement in Justice Department history ($1.7 billion).  Senator Chuck Grassley publicly questioned whether the settlement was too small, compared to the amount of money HCA had taken from the taxpayers.

The case was quietly settled while Frist was securing votes to become majority leader, about a month before HCA execs were scheduled for depositions.

Multiple HCA subsidiaries pled guilty to crimes.  The "sweetheart" settlements kept some executives out of jail and allowed HCA to continue feeding at Medicare's trough.  More than one-third of HCA's profits came from Medicare billing.

HCA systematically drained hundreds-of-millions from our nation's largest healthcare programs, including Medicaid, Medicare and TRICARE (military health).

One scheme was called "upcoding"(billing the government for more-expensive ailments than patients actually had).  The scheme was low-risk, because the government couldn't monitor all patients' actual conditions.

Another involved billing the government for lab tests that doctors hadn't ordered or that weren't medically necessary.

Yet another involved kickbacks paid to doctors for referring government-insured patients to HCA facilities.  Kickbacks were illegal under Medicare's Anti-Kickback statute, but what better way to increase HCA's billing?

In a nutshell, lucrative legal infractions were not uncommon for Frist's family business.

Even before merging with Columbia, HCA allegedly kept two sets of books for Medicare and Medicaid billing.  One contained unallowable costs billed to the government.  The other showed how much HCA would have to pay back if government auditors spotted those "costs."

After the merger, Columbia/HCA's strategy included buying hospitals and slashing staff to boost profits.  Reportedly, the quality of patient care suffered.

According to the Polaris Institute, a former HCA obstetrician reported increased childbirth-related deaths after Columbia/HCA bought the hospital where he worked.  A technician at another HCA hospital said that she, alone, sometimes had to watch 72 patients' heart monitors due to staff shortages.

Under-staffed hospitals are breeding grounds for legitimate malpractice suits.

Now sweat for the family business: Senator Frist raised his sword for tort "reform," to limit damages rightly owed by hospitals that put profits above patients.

According to LA Weekly, Frist also fought against allowing patients to sue HMOs and tacked a rider onto a Homeland Security bill to shield Eli Lilly from lawsuits over Thimerosal (a mercury-based vaccine-preservative that may cause autism in children).

In short, Senator Frist has a history of defending Big Health at citizens' expense, which is why his moves to protect vaccine manufacturers are not surprising.

What is surprising is that the dirt-hungry media has forgotten Frist's and his family-business's history---though both are key to understanding this man who may still by eyeing a Whitehouse run in 2008.