Cliff Cloonan: There's no way that you can do that and not have it be fraudulent because you're not admitting on the basis of medical requirements, you're basing it on strictly an arbitrary number that has been pulled out.
Steve Kroft: All sorts of businesses set quotas. What's wrong with this?
Scott Rankin: We're not building widgets. We're taking care of patients who are ill and come in to the emergency department.
Jeff Hamby was an emergency room doctor at HMA's Summit Medical Center in northwest Arkansas. He says he was fired for not meeting admission targets and is suing HMA for wrongful termination. HMA maintains no one has ever been fired over admission numbers. Hamby called the targets "coercion to commit fraud."
Jeff Hamby: Initially it was 15 percent. They kept trying to up it.
Steve Kroft: They didn't care how you got there? They just wanted you--
Steve Kroft: They're saying, "You will admit these people whether they're sick or not, whether they need to be hospitalized?"
Scott Rankin: Correct--
Cliff Cloonan: They never phrase it that way. They did say admit 20 percent. The reality of that is that there's only one way that that can happen. And that is if it is arbitrary. That is, if you do admit patients that don't need to be admitted.
Scott Rankin: For patients who were 65 and over, the benchmark was 50 percent.
Steve Kroft: Those would be Medicare patients?
Scott Rankin: Correct.
Steve Kroft: You're saying it's not a good idea to admit half the patients over 65?
Cliff Cloonan: If you are put into the hospital for reasons other than a good, justifiable medical reason, it puts you at significant risk for hospital-acquired infections and what we would refer to as medical misadventures.
These stories are echoed in many of the thousands of documents we examined, including emails like this one from a hospital executive in Durant, Okla., pressuring her staff during emergency room shifts.
[Graphic: "Only 14 admits so far!!!!!!! Act accordingly...."]
And this email from an ER director at an HMA hospital in South Carolina to a new emergency room doctor.
[Graphic: "Every time a 65 year old or older comes in, I am already thinking, do they have some condition I can admit them for?"]
[Graphic: "We are under constant scutiny[sic]]."
[Graphic: "I will be blunt... I have been told to replace you if your numbers do not improve."]
Steve Kroft: In your dealings with HMA, did you ever get any sense that this was commercially driven?
Jeff Hamby: Of course. I can't imagine any other explanation to admit a percentage.
Nancy Alford: The administrators said that daily, frequently. "We don't make any money if we do this. We make more money if we do that."
Steve Kroft: Admit more patients?
Nancy Alford: Admit more patients, keep them longer. Money was the chief motivator.