Medical Care Industry

The federal investigation of Columbia/HCA Healthcare Corp. expanded to Las Vegas on Wednesday when state and federal agents conducted a search of Sunrise Medical Center, Nevada's biggest hospital. Agents from the state's Medicaid fraud division and the FBI conducted a search of the Columbia-owned hospital in connection with a criminal investigation of the facility, Nevada Atty. Gen. Frankie Sue Del Poppa confirmed.

It has been trumpeted as a "shot across the bow of the ship called managed care," a "crack in the [insurance industry's] Wall of Jericho" and the consuming public's "line in the sand." A San Diego County Superior Court jury's $1.75-million award to a doctor who claims that he was fired for spending too much time and money on patients is resonating far beyond the confines of the Southern California courtroom.

Contrary to the claims of most managed care companies and employers, many of the new protections being sought by health care consumers and their congressional allies would only slightly increase the price of health insurance, according to a detailed study by a major accounting firm.

Dr. Thomas LaGrelius turned his back on managed care in the early 1980s. A manager of a South Bay medical group, LaGrelius said he was deeply disturbed when a Southern California HMO asked doctors to postpone all elective surgeries for patients for four months--an "unethical" move that he contends was driven by financial considerations. Health-maintenance organizations have changed a lot in the 15 years since that incident occurred, but LaGrelius' opinions of them have not.

The Justice Department said it will join in a lawsuit against Columbia/HCA Healthcare Corp. by an ex-employee who says the nation's largest hospital chain systematically defrauded Medicare and other government health insurance programs. The Justice Department action marks the second time it has joined in a so-called whistle-blower lawsuit against the Nashville-based company, which is also the subject of a criminal fraud probe.

Health Care: The new year will bring higher health insurance premiums for just about everyone--even people in restrictive HMOs such as Kaiser, which is raising rates 11% for the coming year. The problem? Consumers and politicians demand better care, but providers don't have the money to pay for it, for reasons ranging from bad management to intense competition.

Once upon a time, your "health care provider" was the doctor who moved to town, hung out a shingle, knew your name and treated you and your family for a lifetime. How simple. How outdated. Today, getting to a doctor most likely means diving into the confusing and often impersonal sea of managed care, mastering the language of plans and provider networks, following dizzying arrays of protocols and dealing with intermediaries who determine access to doctors and hospitals.

What do physicians have in common with the former Soviet republic of Moldova? Both share the initials MD. In the case of physicians, the letters stand for "medical doctor." For the European nation, they form the top-level domain in its Internet addresses. A Beverly Hills start-up is hoping to capitalize on the coincidence by licensing domain names ending in .md, such as "UniversityHospital.md" or "JohnDoe.md." Professional Domains, through an arrangement with a Bonita Springs, Fla.

Professional relationships in medicine tend to be genteel to the point of boring. Sure, disagreements and ego clashes occur all the time, but they are usually quiet affairs, rarely surfacing outside of hospital, laboratory and medical school corridors of gossip. So, when two icons of American medicine toss off their white coats and go public with their feud, the issue is bound to be a sizzler. In this case, it's alternative medicine.

Saying that the issues "go to the heart of the public's confidence" in the Food and Drug Administration, three senior House Democrats are seeking answers to extensive questions about the agency's approval of the diabetes pill Rezulin. In a four-page letter to Dr. Jane E. Henney, the newly installed FDA commissioner, Reps. John D. Dingell of Michigan, Sherrod Brown of Ohio and Henry A.