"WASHINGTON -- Two of the largest names in healthcare insurance are buying out their competition, triggering an investigation by the U.S. Department of Justice (DOJ) and expressions of concern from hospital and physician groups, as well as Congress.

In July, Aetna announced plans to acquire Humana for $37 billion. Just a few weeks later, Anthem revealed it was merging with Cigna in a $48 billion deal.

Critics say merging four of the five biggest insurers in the nation will kill competition, causing premiums to rise, benefits to narrow ,and provider payments to decline.

"Once [these deals are] consummated, there is simply no going back," said Andrew Gurman, MD, president-elect of the American Medical Association, in testimony before the House Judiciary Committee last week.

"You cannot unscramble an egg," said Gurman, who is an orthopedic hand surgeon based in Altoona, Pa.

Proponents of the mergers (namely, industry executives) argued that consolidating these four businesses would reduce administrative costs and expand networks, allowing companies to provide a broader array of products and services. The mergers would also accelerate the transition to value-based care and strengthen healthcare analytics, they said."

Read More at MedPage Today

Too many to post individually over the last few days:

Bristol-Myers Squibb To Pay $14 Million To Settle Charges Of Bribery
California Woman Pleads Guilty In Medicare, Medicaid Fraud Scheme
Columbus Regional Agrees To Pay $35M Over Medicaid Fraud Claims
Atlanta Hospice Reaches $3 Million Settlement In Medicare Fraud Case
Government Accountability Office Report Highlights Improper Payments In Medicare, Medicaid



Bristol-Myers Squibb To Pay $14 Million To Settle Charges Of Bribery.

"WASHINGTON (AP) -- Bristol-Myers Squibb will pay $14.6 million to settle charges from U.S. regulators that its joint venture in China gave cash and other benefits to government health care providers to boost drug sales.

The Securities and Exchange Commission announced the settlement of civil charges Monday with the company, one of the largest drugmakers in the world. Bristol-Myers Squibb, based in New York, makes and sells prescription and over-the-counter medicines worldwide."

Read more at AP



California Woman Pleads Guilty In Medicare, Medicaid Fraud Scheme

"LOS ANGELES – A Placentia woman pleaded guilty Monday to a federal charge stemming from the operation of a hospice that submitted millions of dollars in fraudulent bills to Medicare and Medi-Cal.

Sharon Patrow, 44, entered her plea to a health care fraud count before U.S. District Judge S. James Otero, who set a May sentencing date. Patrow's mother, Priscilla Villabroza -- who is serving a 4 1/2-year term at a federal prison in Victorville for running a separate health care fraud scheme -- is also charged in the case.

The mother and daughter, along with four others, were charged in December with 25 health care fraud and money laundering counts, each of which carries a potential multiple-year prison sentence, according to the U.S. Attorney's Office.

The case involves the formerly Covina-based California Hospice Care, which Villabroza purchased in late 2007 while under investigation in the earlier case, prosecutors said.

Officials allege that between March 2009 and June 2013, California Hospice submitted nearly $9 million in fraudulent bills to Medicare and Medi- Cal for purportedly providing end-of-life care to patients who were, in fact, not dying. The public health programs paid nearly $7.5 million on those allegedly bogus bills."

Read more at OC Register



Columbus Regional Agrees To Pay $35M Over Medicaid Fraud Claims

"COLUMBUS — Last week, the hospital business in Georgia’s second-largest city received a double dose of financial misery. The first round of bad news centered on Columbus Regional Health. State Attorney General Sam Olens announced Friday that Columbus Regional and other related entities had agreed to pay Georgia and the United States up to $35 million to resolve allegations of false Medicaid claims.

Then the Columbus Ledger-Enquirer reported Saturday that the other hospital organization in town, St. Francis, has been told by the feds that it must repay $21.4 million and make major changes in the way it does business. The federal audit report came 10 months after St. Francis said it could not account for about $30 million on its financial books."

Read more at Albany Herald



Atlanta Hospice Reaches $3 Million Settlement In Medicare Fraud Case

"A Georgia hospice company has agreed to pay $3 million to resolve allegations it billed taxpayers for patients who were not terminally ill, the latest such settlement as federal officials target what they call a burgeoning number of abusive hospice schemes.


Guardian Hospice set aggressive targets to recruit and enroll patients it knew were not in the last months of their lives so it could collect Medicare payments, the federal government alleged. In agreeing to the settlement, the for-profit company, which serves the Atlanta area, did not admit liability."

Read more at AJC




Government Accountability Office Report Highlights Improper Payments In Medicare, Medicaid

WASHINGTON: Three health and safety net programs for the poor and elderly accounted for most of the federal government’s $124.7 billion in improper payments in fiscal 2014, the Government Accountability Office reported Thursday.

"The figure, which represents improper payments across 124 federal programs, is up roughly 20 percent from $105.8 billion in fiscal 2013, according to a new GAO report.

Most of the $19 billion increase resulted from erroneous payments under the Medicare, Medicaid and Earned Income Tax Credit programs. They account for more than 75 percent of the GAO’s government-wide improper payment estimate.

Improper payments are those made in error or in an incorrect amount and can include duplicate payments, those made without proper documentation or to ineligible recipients, and payments for ineligible goods and services.

They can result from fraud, unintentional clerical errors or a host of other reasons.

Nearly $1 trillion in improper federal payments have been made since 2003, when a federal law began requiring certain agencies to report the amounts."

Read more at McClacthyDC

"Medical giant Cedars-Sinai Health System said Tuesday it has acquired nearby Marina Del Rey Hospital, adding to a flurry of similar healthcare deals. Cedars-Sinai said it has purchased the 145-bed hospital and its neighboring medical office building. The price wasn't disclosed.

Marina Del Rey Hospital will operate as an affiliate of Cedars-Sinai and continue to provide its existing services, including a 24-hour emergency room. All 660 hospital employees will remain in place, according to Cedars-Sinai.

Marina Del Rey Hospital was owned by a partnership led by Westridge Capital, a private investment firm based in Los Angeles.

The deal fits in with Cedars-Sinai's ongoing efforts to expand and make care more convenient to patients in the community. It's also part of a larger consolidation trend among U.S. hospitals and, more recently, big health insurers."

Read more at LA Times

"Los Angeles-based managed care provider Health Net is being acquired by Centene Corp. in a deal valued at $6.8 billion. The deal could mean job losses at Health Net offices in Rancho Cordova, where more than 2,400 of the Woodland Hills-based health insurer's employees work.

The deal, which is expected to close by early 2016, will add Health Net's Medicare platform to Centene's existing Medicaid programs and create a managed care firm with more than 10 million members nationwide and approximately $37 billion in revenue."

Read more at Biz Journals.