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Monthly Archives: January 2020

California physician gets 15 months in prison for $900M kickback scheme

Alia Paavola – Friday, January 17th, 2020 Print  | Email

The former owner of Long Beach, Calif.-based Pacific Hospital received a 15-month prison sentence for his role in a kickback scheme that led to more than $900 million in fraudulent bills being submitted, according to Bloomberg Law. 
Faustino Bernadett, MD, paid more than $30 million to physicians, chiropractors or marketers who would then refer patients to Pacific Hospital for spinal surgeries and other medical services.
Dr. Bernadett, who pleaded guilty last August, attempted to conceal the kickback payments using sham contracts. The scheme took place from about 2008 to 2010 and resulted in $900 million in fraudulent bills, primarily to the California work compensation system. 
He was sentenced Jan. 17 by U.S. District Judge Josephine Staton, who also ordered Dr. Bernadett to pay a $60,000 fine. Dr. Bernadett previously was ordered to forfeit $1 million to the government. 
More articles on legal and regulatory issues:
Feds recovered $2.6B from healthcare fraud cases in 2019CHS reaches $53M deal in class-action stock drop lawsuitWisconsin health system will pay $10M to settle whistleblower case

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Kentucky hospital, Anthem reach agreement

Morgan Haefner – Friday, January 17th, 2020 Print  | Email

Murray (Ky.)-Calloway County Hospital and Anthem struck a contract agreement that allows Anthem members to maintain in-network status at the hospital, the organizations said Jan. 15.
Anthem and the hospital have been negotiating a new contract for several months. The organizations came to an agreement before a Feb. 15 deadline. 
“From the outset, we were quite confident that we would reach an agreement that was in the best interests of both organizations and most importantly, for the patients we collectively serve,” Jerry Penner, Murray-Calloway County Hospital’s CEO, said in a news release.
More articles on payers:Ex-Cigna exec: I helped create the health insurance ‘choice’ talking point, and regret itOptum helps boost UnitedHealth profit past $5B in Q4Cigna, Oscar strike partnership: 5 things to know

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297%: The average difference between highest, lowest outpatient charges, study says

Morgan Haefner – Friday, January 17th, 2020 Print  | Email

Nationally, the difference between the lowest and highest gross charges for individual outpatient procedures in the U.S. averaged 297 percent, according to a study from consulting firm Crowe.
In its report, Crowe analyzed financial transactions at more than 1,200 hospitals in the U.S. captured through its revenue cycle analytics solution. Crowe focused on individual pricing levels of 100 common outpatient procedures that had gross charges above $500. These are the list prices hospitals post in their system.
In one example, the report found the specific billing code for a high-severity, potentially life-threatening emergency room visit resulted in an average gross charge of $3,499 for the most expensive hospitals. For the least expensive, the average gross charge was $692, or a 406 percent difference.Big pricing disparities were identified on a local basis, too. For a standard MRI procedure in a metropolitan area of more than 3 million, Crowe found a 115 percent difference between the highest gross charge ($4,548) and the lowest ($2,115).To view the full report, click here.More articles on healthcare finance:West Virginia health system files for bankruptcyWashington hospital closes ER, lays off 463 employeesMissouri hospital abruptly closes, misses payroll

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Hospital-linked dark money group launches pricey ad blitz in Colorado

A dark money group that has poured money into fighting “Medicare for All” and other federal healthcare proposals by Democratic presidential candidates is now taking aim at healthcare reform efforts in Colorado, according to Colorado Public Radio.
Colorado’s Health Care Future, part of an advocacy group called Partnership for America’s Health Care Future, has paid to air hundreds of advertisements and send mailers to Colorado residents in an attempt to defeat a bill that doesn’t exist yet. The bill, which is expected to be introduced by Colorado’s Democratic legislators, would create a public insurance option.
Colorado Gov. Jared Polis said Colorado hospitals are funding the ads, but the Colorado Health Association contested that claim. It’s impossible to know who is paying for the ads because groups like Partnership for America’s Health Care Future don’t disclose donors’ names or the amount they donated, according to the report.
The advocacy group is composed of physicians, nurses, hospitals, health insurers, biopharmaceutical companies and other organizations, a spokesperson told Colorado Public Radio. Though a full list of donors isn’t available, Partnership for America’s Health Care Future has identified Nashville, Tenn.-based HCA Healthcare and the Federation of American Hospitals as supporters.
The ads paid for by the group claim a public insurance option would negatively affect hospitals. Lower reimbursement under a public insurance option could put 23 rural hospitals in Colorado at higher risk of closure, according to a report released by Colorado’s Health Care Future and FTI Consulting.
Colorado Sen. Kerry Donovan, D-Vail, disputes the advocacy group’s claims. Mr. Donovan, who is sponsoring the bill with Colorado Rep. Dylan Roberts, D-Avon, told The Denver Post the proposed policy will not close rural hospitals or put people out of jobs.
More articles on healthcare finance:
Hospital groups sue HHS, seek to block site-neutral pay cutsAggressive creditor forced hospital chain into bankruptcy, CEO says7 latest hospital credit rating downgrades
 
 

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Missouri hospital hit with class-action suit over failure to pay for employees' insurance

Employees filed a class-action lawsuit against Pinnacle Regional Hospital in Boonville, Mo., on Jan. 15, the same day it abruptly closed, according to KCUR.
Pinnacle Regional, which gave less than one day’s notice before it shut down, allegedly failed to pay for employees’ health insurance premiums after promising it would do so. As a result, employees were allegedly left with unpaid medical bills not covered by insurance, according to KCUR. 
Douglas Palzer, who bought Pinnacle Regional in 2018, provided some details about the hospital’s financial situation in an email to employees Jan. 16. He said employee payroll and benefits will be two of Pinnacle’s top priorities as funds come in. The hospital missed its regularly scheduled payroll Jan. 15.
Mr. Palzer also said Pinnacle Health Care System, the Boonville hospital’s parent company, may file for Chapter 11 bankruptcy protection.
The lawsuit filed by employees, which seeks damages for fraud and other counts, is one of several legal matters pending against Pinnacle Regional. A healthcare staffing company is suing the hospital for alleged nonpayment of more than $200,000, and a physician services company is suing for alleged nonpayment of $24,000. Last year, a laboratory services company sued Pinnacle Regional for nonpayment and obtained a $92,000 default judgment, according to the report.
More articles on healthcare finance:
Hospital groups sue HHS, seek to block site-neutral pay cutsAggressive creditor forced hospital chain into bankruptcy, CEO says7 latest hospital credit rating downgrades
 
 
 

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Healthcare predictions for 2020: Health systems will get bigger, demand for physicians will grow

There are seven healthcare industry sectors ripe for growth, consolidation and investment in 2020, according to a report from Epstein Becker Green and EBG Advisors.
Based on their experience advising clients in the healthcare industry, the attorneys and advisors who authored the report predict the aging baby boomer population, advances in technology and the goal of reducing healthcare costs will drive transformation in the healthcare industry this year. According to the report, the following seven sectors will see growth, consolidation and increased investments in 2020:
1. Hospitals and health systems will expand both regionally and nationally to increase capital and achieve economies of scale in connection with investments in new facilities and services as well as advanced capabilities to better manage care.  
2. Because physicians act as “key quarterbacks” in controlling healthcare costs, they’ll see more competitive offers from hospitals, health plans and other organizations.
3. The aging baby boomer population will drive increased demand for long-term care services.
4. Funding for behavioral health services, including those to treat substance use disorders and mental health illnesses, will increase.
5. Health information technology, including analytics, artificial intelligence, and mobile apps, is poised for growth because of its key role in helping providers deliver high-quality healthcare at a lower cost.
6. Growth in the medical device and pharmaceutical sector will be driven by new scientific discoveries being developed to treat certain conditions more effectively at a lower cost.   
7. Enrollment in Medicare Advantage plans will increase as the number of Medicare enrollees grows and the Medicare program adopts bundled payments, risk-based initiatives and other models of care.
Access the full report from Epstein Becker Green here.
More articles on healthcare finance:
Hospital groups sue HHS, seek to block site-neutral pay cutsAggressive creditor forced hospital chain into bankruptcy, CEO says7 latest hospital credit rating downgrades
 

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19 latest healthcare industry lawsuits, settlements

From hospital groups suing HHS over Medicare payment policies to Cigna filing a lawsuit against health clinics in Texas, here are the latest healthcare industry lawsuits and settlements making headlines.
1. Aggressive creditor forced hospital chain into bankruptcy, CEO saysAmericore Health and its affiliated hospitals were forced to file for Chapter 11 bankruptcy in late December after a lender hijacked the company’s bank accounts, Americore Founder and CEO Grant White alleges in court documents.
2. Texas physician guilty in $325M fraud case involving false diagnosesA Texas physician was found guilty Jan. 15 for his role in a $325 million healthcare fraud scheme that involved falsely diagnosing patients with various degenerative diseases and then administering chemotherapy and other toxic drugs to patients based on the false diagnoses.
3. Feds allege Theranos caused patient harm via false HIV, pregnancy test results  After Theranos founder Elizabeth Holmes filed a motion last month to get patient-related felony charges dismissed in her indictment, federal prosecutors filed a response detailing allegations of inaccurate test results and the harm they caused those patients.
4. Cigna sues Texas clinics for $2M in claimsA Cigna subsidiary in Texas filed a lawsuit that alleges three dissolved clinics, their owner, a manager and managing physicians defrauded the health insurer through a billing scheme.
5. Nurses lose bid to keep Washington hospital openA bankruptcy judge on Jan. 14 denied a request from the Washington State Nurses Association to reconsider an order allowing Astria Regional Medical Center in Yakima, Wash., to close.
6. Tennessee physician charged in $7M healthcare fraud conspiracyA Tennessee physician was charged for his alleged role in a $7 million fraud scheme involving false Medicare claims.
7. Trump administration brings ‘public charge’ rule battle to Supreme CourtThe Justice Department called on the Supreme Court Jan. 13 to lift a nationwide block on the “public charge” rule, which would allow the administration to begin denying immigrants green cards if they have used public benefits like Medicaid.
8. Hospital groups sue HHS, seek to block site-neutral pay cutsTwo organizations representing hospitals and health systems across the nation and several individual hospitals sued HHS Jan. 13 over site-neutral payment cuts for 2020.
9. Physicians association sues US congressman, cites ‘reputational injury,’ after website visits dropThe Association of American Physicians and Surgeons is suing U.S. Rep. Adam Schiff for asking social media platforms to remove inaccurate vaccine information, saying his request amounts to censorship of free speech.
10. South Carolina hospital escapes suit over physician’s lack of adequate insuranceAn appeals court affirmed the dismissal of a lawsuit seeking unpaid medical malpractice awards from a South Carolina hospital.
11. ResMed to pay US $37.5M to settle kickback allegationsResMed, a medical devicemaker based in San Diego, agreed to pay the U.S. $37.5 million to resolve claims that it provided free goods and services to companies to sell more of its equipment.
12. Ballad antitrust lawsuit heads to federal appeals courtTennessee residents suing Johnson City, Tenn.-based Ballad Health for an anticompetitive board structure appealed a judge’s decision to dismiss the case.
13. Dignity Health isn’t owed millions from Medicaid insurer, appellate court rulesUpholding a lower court decision, a California appellate court rejected San Francisco-based Dignity Health’s lawsuit claiming that L.A. Care Health Plan owes it hundreds of millions of dollars in out-of-network payments for inpatient stabilization post-emergency. 
14. Endo settles Oklahoma opioid case for $8.8MEndo Pharmaceuticals agreed to pay $8.8 million to Oklahoma to settle claims its marketing played a role in fueling the opioid crisis.
15. Physician, salesperson charged in $12M fraud scheme against insurerFederal prosecutors accused an Arkansas physician and a medical sales representative of participating in a scheme to defraud Tricare, the U.S. military health insurer.
16. Court dismisses Beaumont’s lawsuit over denied hospital applicationA Court of Claims dismissed a lawsuit filed by Southfield, Mich.-based Beaumont Health that claimed Michigan regulators wrongly rejected its application to build a hospital.
17. Oklahoma sues McKesson, Cardinal, AmerisourceBergen over the opioid crisisOklahoma Attorney General Mike Hunter filed a lawsuit Jan. 13 against Cardinal Health, McKesson and AmerisourceBergen, three of the country’s largest drug distributors, alleging they helped fuel the opioid crisis by funnelling “unreasonable” amounts of opioids into the state.
18. Roche pulled a $1.5B fast one on US, whistleblower physician allegesRoche allegedly misled the U.S. government about the effectiveness of its drug, Tamiflu, at combating a flu pandemic, causing the government to unnecessarily spend $1.5 billion to stockpile the drug.
19. New York hospital seeks dismissal of lawsuit alleging human trafficking law violationsAlbany (N.Y.) Medical Center seeks to dismiss a union lawsuit accusing the hospital of federal human trafficking law violations linked to its program to recruit nurses from the Philippines to work in the hospital.
More articles on legal and regulatory issues:
Feds recovered $2.6B from healthcare fraud cases in 2019CHS reaches $53M deal in class-action stock drop lawsuitWisconsin health system will pay $10M to settle whistleblower case
 

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Newark Beth Israel put patients in 'immediate jeopardy,' CMS says

Gabrielle Masson – Friday, January 17th, 2020 Print  | Email

Newark (N.J.) Beth Israel Medical Center’s heart and lung transplant program put patients in “immediate jeopardy,” and, even after planning corrective measures, the hospital still isn’t in compliance with all federal standards, ProPublica reports.
The hospital’s transplant program failed to fix mistakes numerous times, allowing “subsequent adverse events to occur,” according to a pair of CMS reports sent to the hospital Dec. 12. Consequently, CMS determined that patients were in “immediate jeopardy.”
Over seven months, three patients suffered brain damage, according to the reports. For two events, CMS found no evidence that hospital reviews of the events occurred. Then, starting in September 2018, the hospital kept the third patient in a vegetative state alive for a year to improve its transplant program’s survival rate.
The reports also cite violations of patient rights, such as failing to obtain informed consent and seek information from patients and family on advance directives.
Newark Beth Israel does not believe the “immediate jeopardy” was warranted, hospital spokesperson Linda Kamateh said in a statement to ProPublica, adding that the hospital intends to send CMS a letter identifying specific objections. Regarding the hospital’s failure to correct mistakes, Ms. Kamateh said the CMS investigators lack the “evidence, expertise and experience” to evaluate and diagnose patient outcomes.
The hospital submitted policy changes Dec. 15, and the New Jersey Department of Health determined the measures sufficient, removing the “immediate jeopardy” designation.
The hospital is currently reviewing required correction plans before submitting them to CMS, Ms. Kamateh said, part of which includes a newly developed transplant steering committee to oversee the program.  
Newark Beth Israel is still not in compliance with federal rules for quality assessment and performance improvement, surgical services, patient rights and special requirements for transplant centers, according to a Jan. 12 CMS letter to the hospital cited by ProPublica. If issues are not resolved by March 21, CMS wrote, steps will be taken to remove Newark Beth Israel from the Medicare program. 
More articles on clinical leadership and infection control:VA hospital deaths prompt House bill mandating safety reportsAllegheny Health Network cancels surgeries after Cardinal Health puts hold on surgical gownsFlu has killed 6,600 Americans, CDC estimates

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State bans Florida physician from treating women

Gabrielle Masson – Friday, January 17th, 2020 Print  | Email

The Florida Department of Health has banned a physician from treating women after he inappropriately touched a patient’s breasts multiple times, the Miami Herald reports.
The emergency restriction order was placed Jan. 13 on gastroenterologist Subhash Gupta, MD, after a woman visited Pompano Beach, Fla.-based North Broward Hospital Sept. 7 for colitis of the large intestine. According to the order, Dr. Gupta groped the patient, identified as “S.L.,”  cupping her breast under her shirt without warning and without a stethoscope. 
Dr. Gupta did the same thing the next day, according to the order, and once more when S.L. came back for a final exam Sept. 13.
“Dr. Gupta cupping patient S.L.’s breasts is outside the scope of practice and not for a medically recognized diagnostic or treatment purpose,” the order concluded.
Since receiving his license in 1983, Dr. Gupta has been disciplined after accusations of poor record-keeping and inadequate medical care. He was also fined $12,500 in 2011 for performing an upper gastrointestinal endoscopy on a patient without consent or confirming her identity. 
More articles on integration and physician issues:
8 ER physicians quit Chicago hospitalMorgan State plans to open osteopathic medical school in BaltimoreU of Nebraska Med Center carves out new allergy, immunology division
More articles on integration and physician issues:8 ER physicians quit Chicago hospitalMorgan State plans to open osteopathic medical school in BaltimoreU of Nebraska Med Center carves out new allergy, immunology division

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Study: Women in leadership face more sexual harassment

Women with authority in the workplace are not immune to sexual harassment. In fact, new research confirms just the opposite: Women in management positions experience 30-100 percent more sexual harassment than other female staff.
The study, from the Swedish Institute for Social Research at Stockholm University, builds and expands on previous research in this area that has discussed the so-called “Paradox of Power.” Researchers conducted a survey in Sweden, the U.S., and Japan. They found consistently across all three countries that women in positions of power experienced more harassment than their counterparts in other roles. Women at lower levels of leadership experienced the most harassment, though it remained substantial for women all the way up the ladder.
“When you think about it, there are logical explanations: a supervisor is exposed to new groups of potential perpetrators. She can be harassed both from her subordinates and from higher-level management within the company. More harassment from these two groups is also what we saw when we asked the women who had harassed them,” Johanna Rickne, professor of Economics at the Swedish Institute for Social Research in Stockholm, said in a press release.
Read more here.
More articles on leadership and management:
8,000 Swedish Medical Center workers schedule strike for Jan. 28-30Mayo Regional, Northern Light Health merger gets state approvalMedPAC recommends 3.3% payment boost for hospitals in 2021

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