Group accuses Tenet Healthcare of violations

WORCESTER – St. Vincent Hospital failed to fully meet federal regulations that require hospitals to accurately and publicly disclose what they charge patients for medical services, according to a report by the nonprofit Patient Rights Advocate.

Two other Tenet Healthcare hospitals in Massachusetts also failed in this area, according to the report: MetroWest Medical Center in Framingham and MetroWest Medical Center - Leonard Morse Hospital in Natick.

A spokeswoman at for-profit Tenet in Dallas said the report doesn't hold water because the Centers for Medicare and Medicaid Services, an agency of the federal Department of Health and Human Services, is the only entity qualified to call out a hospital for failing to disclose accurate pricing.

The spokeswoman also mentioned the Centers for Medicare and Medicaid Services has not cited any Tenet hospital in Massachusetts for noncompliance with the law. No Tenet hospital nationwide fully met the pricing regulation, according to Patient Rights Advocate's study, which looked at 66 Tenet hospitals.

A request to the Centers for Medicare and Medicaid Services to confirm it hasn't found Tenet hospitals in Massachusetts in violation of the regulations was not returned by deadline.

"Centers for Medicare and Medicaid Services (CMS) is the only qualified and credible source for this information, and neither of our hospitals in Massachusetts has been found to be out of compliance with the price transparency rule by CMS," a Tenet statement reads.

"Rather, it is a private, nongovernmental patient advocacy organization called Patient Rights Advocate.org that is making this accusation. As required by the federal price transparency rule, our hospital websites provide lists of services and standard charges, as well as a price estimating tool, and a contact number for patients with additional questions."

Different take

While Tenet said it hasn't run afoul of federal hospital price transparency regulations that went into effect Jan. 1, 2021, the nonpartisan Patient Rights Advocate doesn't see it that way.

In the case of St. Vincent, the report said the hospital is not disclosing all prices for services that it negotiated with insurance companies.

"Employers, unions, all of us can't see the prices, can't compare them, and see they might have been overcharged. They can't comparison-shop," said Cynthia Fisher, founder and chairwoman at Patient Rights Advocate.

Tenet hospitals in Framingham and Natick did not disclose discounted cash prices that are lower than the prices negotiated with insurance companies, according to the report.

"We have to fix the greed that has run amok," said Fisher.

Tenet reported total revenues of $19.4 billion for 2021, compared to $17.6 billion in 2020.

A federal appeals court in December 2020 rejected a move by the American Hospital Association to block the pricing regulations from going into effect. The American Hospital Association claimed patient prices negotiated with insurance companies aren't always known because the level of care varies among patients. The appellate court reportedly shot down that argument, claiming hospitals can post base prices negotiated with insurers, even if the actual cost in the end doesn't match the base price.

Other findings

Other findings from the Patient Rights Advocate study: Eight of 20 hospitals in Massachusetts (40%) fully comply with price disclosure regulations including UMass Memorial Medical Center – University Campus. Nationally, 75% of the 2,000 hospitals in the study were found to be in noncompliance. The 2,000 hospitals chosen for the study represent the largest health care systems in the country, and are roughly a third of the 6,000 hospitals in the U.S.

Financial stick

To force hospitals to comply with open and honest pricing, Fisher said the Centers for Medicare and Medicaid Services has the power to hit a hospital with fines that can reach $2 million annually.

The Centers for Medicare and Medicaid Services has reportedly not taken that step, after issuing more than 300 warnings to hospitals after the first year of the federal pricing regulation. The agency reportedly believes hospitals cited for infractions have either corrected the problem or are working to fix it.

As Fisher of Patient Rights Advocate sees it, it's time for the Centers for Medicare and Medicaid Services to start issuing fines because it's the tool the government has to protect patient rights.

"Hospitals are disregarding the language so clear in the law and they're putting profits over patients," she said. "As long as they hide prices, they can charge whatever they want."

Contact Henry Schwan at henry. [email protected]. Follow him on Twitter @henrytelegram.

Massachusetts hospitals

Here is the list of Massachusetts hospitals that comply with the regulations and those that don't.

Those that comply:

Baystate Medical Center

Beth Israel Deaconess Medical Center

Boston Medical Center

Brigham and Women's Faulkner Hospital

Brigham and Women's Hospital

Massachusetts General Hospital

Tufts Medical Center

UMass Medical Center – University Campus

Those that don't comply:

Boston Children's Hospital

Charlton Memorial Hospital

Holy Family Hospital – Methuen

Lahey Hospital and Medical Center Burlington

Lowell General Hospital

Mercy Medical Center

MetroWest Medical Center – Framingham

MetroWest Medical Center – Leonard Morse Hospital - Natick

St. Elizabeth's Medical Center

St. Luke's Hospital

St. Vincent Hospital

South Shore Hospital