Dear Ms. Corrigan:
By letter dated, Oct. 31, 2003, Blue Cross of California (BCC/Blue Cross), notified Tenet Healthcare Corporation (Tenet) that it was referring some of its members to alternative participating hospitals for any medically necessary coronary bypass procedures. The notice states that, “[n]umerous improper, medically unnecessary Coronary Artery Bypass Graft (“CABG") procedures have been performed on BCC Members and improperly billed to BCC." On Saturday, Nov. 1, 2003, The Los Angeles Times (The Times) reported that BCC had data suggesting that doctors at Tenet’s hospitals in Redding and Modesto performed unnecessary heart surgeries. Specifically, TheTimes quoted Dr. Woodrow Myers, chief medical officer for BCC saying that, “a review by independent cardiologists of 52 bypass operations at those hospitals had concluded that 85% of thesurgeries at Redding had been unnecessary and that 59% at Tenet’s Doctors Medical Center inModesto had been unwarranted." The numbers cited by Dr. Myers, if accurate, are truly shocking.
As Chairman of the Senate Finance Committee (Committee), I request that the Departmentof Health & Human Services (HHS), Office of Inspector General (OIG) investigate whether unnecessary cardiac procedures and surgeries, paid for under federal health care programs, may have been performed at Doctors Medical Center in Modesto. The unprecedented action taken by Blue Cross on behalf of its members appears, in and of itself, to be cause for alarm. In light of the Department of Justice’s announcement on August 6, 2003, that it had obtained a record-setting $54,000,000 recovery against Tenet based on alleged unnecessary cardiac procedures and surgeries performed at Redding Medical Center, it strikes me as matter of great urgency. Attached for yourinformation is the Blue Cross letter and press release. For your information, by letter dated,Nov. 3, 2003, the Committee requested that Blue Cross share its findings and data related tomedically unnecessary coronary bypass procedures. The Committee requests that HHS-OIG forwardits findings for review by Committee oversight staff.
Please have your staff coordinate with my Committee staff to discuss this matter fully. Wewould appreciate receiving a response before Nov. 14, 2003. Please do not hesitate to contactme if you have any concerns.
Sincerely,
Charles E. Grassley Chairman
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Source: Ranking Member’s News
