Some doctors, nurses and other health-care workers in the District and across the nation have not been paid for as long as two months, and some hospitals and nursing homes may face bankruptcy, because of financial troubles at National Century Financial Enterprises Inc., industry officials said yesterday.
Dozens of health-care companies gathered in an Ohio state court yesterday, near National Century's headquarters, to sort out the health-care financier's situation and seek a way to avoid what some of its customers claim is impending financial collapse. While there is no clear accounting of how much money National Century owes, investors who have bought hundreds of millions of dollars' worth of the company's bonds have hired lawyers to investigate.
"Without funding for the last two weeks, these companies are dying, and patients' lives are at risk," said Angeline Cook, head of investor relations at Med Diversified Inc., a home health-care company that estimates it is owed about $7 million for the past 10 days.
National Century serves as a fast-cash dispenser to struggling hospitals, nursing homes and other health-care providers. It lends them money immediately in exchange for relatively high interest rates and control of the institution's receivables -- money that insurers, HMOs, the government and others are obligated to pay the institutions over time. The company, the largest of its kind, then packages these arrangements into bonds that it sells to investors.
In recent weeks, two leading bond-rating services have said that National Century may not have sufficient reserves to back about $3.35 billion worth of bonds it services. Officials at Fitch Ratings withdrew the ratings on bonds issued by subsidiaries of the company, NPF VI and NPF XII, after officials at National Century "completely cut them out of the loop" about its finances. Fitch downgraded the formerly highly rated bonds in July after it became clear that National Century was having difficulty raising money to purchase new receivables.
Moody's Investors Service lowered its ratings after National Century appeared to use cash reserves inappropriately to finance new deals. In a statement last week Moody's said its action reflects "concern about NCFE's financial stability." This week, Moody's further downgraded the bonds to speculative, or "junk," status.
Among those affected are medical suppliers and outside doctors under contract to the District's Greater Southeast Community Hospital and Hadley Memorial Hospital, who have not been paid in recent weeks. Staff employees are receiving their paychecks, officials said.
National Century is a part owner as well as financier of Doctors Community Healthcare Corp., which owns the two D.C. hospitals.
"There is no doubt we have been struggling in the last days and months as a result of the difficulties NCFE has had," said Paul R. Tuft, chief executive of Doctors Community Healthcare. "This is an incredibly unusual and difficult situation."
As Ohio-based National Century struggled to sort out how it would continue operations yesterday, it also battled health-care providers in court.
On Monday, NPF XII obtained a temporary restraining order in Franklin County, Ohio, Common Pleas Court against 68 providers -- most of them companies that staff nursing homes and hospital emergency rooms. It went to court after some providers asked health insurers and the federal Centers for Medicare and Medicaid Services to send reimbursements directly to them, not to National Century. The court ordered the providers to instruct their payers "to direct all payments" to NPF.
Yesterday, a Franklin County judge heard arguments from lawyers representing the providers who sought to dissolve or, at least, modify the order. As of last night, no decision had been announced.
National Century has been struggling, financially and legally, for months. In February, the U.S. attorney in Baltimore issued a temporary restraining order against another National Century subsidiary, NPF VIII Inc., and related financial companies, saying NPF "advanced only a fraction of the funds necessary for the operation" of BluePoint Nursing and Rehabilitation Center.
U.S. Attorney Thomas M. DiBiagio said the National Century subsidiary inappropriately arranged to take on Medicare and Medicaid receivables from the center's management company, which was the subject of an involuntary bankruptcy filing by creditors. Officials from the National Century subsidiaries denied the government's allegations. Federal law prohibits assignments of Medicare and Medicaid receivables unless approved by a court.
Starting in May, National Century began having trouble selling bonds, the main way it raises capital to buy more hospital receivables.
"This has been catastrophic for many health-care companies," said Ron Lusk, a consultant to New York-based Tender Loving Care Health Care Services Inc., a Med Diversified subsidiary with 7,500 employees who provide home nursing in dozens of communities, including the Washington-Baltimore region. "We're not sure if we can meet our next payroll."