"A group of 32 hospitals will pay a total of $28 million to settle allegations that they submitted false claims to Medicare for a type of spinal fracture treatment, the U.S. Department of Justice said on Friday.
"A case now before the U.S. Supreme Court could mean fewer fraud lawsuits filed against healthcare providers. Or it could at least give them more clarity about what constitutes a violation of the law, experts say.
The Supreme Court announced Friday it would hear Universal Health Services v. United States ex rel Escobar, a case that focuses on one theory whistle-blowers and the government use in bringing False Claims Act cases to court. The act makes it illegal to knowingly submit fraudulent bills to the government, such as for services not actually performed. In a variation of fraud claims, some whistle-blowers allege that providers submitted false claims by failing to follow certain regulations. Providers sometimes are held liable for not following such regulations even if the government never explicitly stated that following a regulation was a condition of payment, and even if the provider never explicitly vouched that it had complied with the regulation. The Supreme Court will consider whether whistle-blowers and the government should be allowed to bring FCA cases under this theory, known as implied certification. “It's a huge deal for healthcare providers,” said Larry Freedman, an attorney with Mintz Levin who defends providers in FCA cases. Legal claims based on implied certification are now “the major driver” of healthcare whistle-blower suits, he added. Lower courts have been divided on the issue, with some saying it's unreasonable to sue organizations under the act for compliance issues arising from the thousands of pages of state and federal rules. Federal and state agencies, not the courts, should deal with such violations, some courts have said. Allowing an implied certification argument in situations where it hasn't been clearly expressed that a regulation is a condition for payment could turn the False Claims Act into “a punitive sanction for use against minor regulatory or contractual violations,” Universal Health argues in court papers." Read more at Modern Healthcare Whistle-blower worries: Hospitals likely to see more False Claims suits tied to doctor compensation11/23/2015
"Dr. Michael Reilly's lawyer gave his client strong advice after reviewing a lucrative employment contract that the North Broward Hospital District offered him 15 years ago.
“I should throw this in the trash,” Reilly, a now-retired orthopedic surgeon, recalls the attorney telling him. The contract, the lawyer said, had major problems, including that it violated the federal Stark law, which bars physicians from referring Medicare patients to hospitals, labs and other doctors that the physicians have financial relationships with unless they fall under certain circumstances. Reilly didn't sign the contract. That moment marked the beginning of Reilly's quest to hold North Broward Hospital District—a taxing district that operates five hospitals in Broward County in South Florida—accountable for alleged violations of the law. Reilly later filed a whistle-blower lawsuit against North Broward under the False Claims Act. In September, North Broward and the government settled the case for $69.5 million, with Reilly getting $12 million. North Broward did not admit to any wrongdoing. It declined to comment for this article. Both plaintiff and defense attorneys predict that more False Claims Act cases alleging Stark violations are on the way, with whistle-blowers largely driving the U.S. Justice Department's enforcement—exponentially multiplying the government's regulatory eyes inside healthcare facilities. That's partly because two giant cases, involving Tuomey Healthcare System and Halifax Health, alerted potential whistle-blowers inside hospitals to the riches they could pocket by bringing such cases, some attorneys say. In October, Tuomey in Sumter, S.C., agreed to settle with the government for $72.4 million, resolving allegations that it paid doctors in ways that rewarded them for referring patients to the hospital. Last year, Halifax in Daytona Beach, Fla., agreed to pay $85 million to settle allegations that it also had compensated physicians in illegal ways. Halifax did not admit to any wrongdoing. The whistle-blower in the Tuomey case got $18.1 million, while the whistle-blower in the Halifax case bagged $20.8 million." Read more at Modern Healthcare "More than 450 hospitals have settled with the government for more than $250 million as part of a yearslong, nationwide investigation into the suspected overuse of implantable cardiac devices, the U.S. Justice Department announced Friday.
The hospital systems involved include many of the country's largest, such as Adventist, Ascension Health, Banner Health, Catholic Health Initiatives, Community Health Systems, HCA, Tenet Healthcare Corp. and Universal Health Services among others. At 42, HCA had the most hospitals involved in settlements and is paying the highest portion of the settlement, $15.8 million, followed by Ascension Health with 32 settling for $14.9 million and then Community Health Systems with 31 settling for $13 million. None of those three systems admitted to any liability as part of their settlements. Community Health Systems said in a statement Friday it agreed to the settlement to “avoid the continuing delay, uncertainty, inconvenience and expense of protracted litigation.” “The issue involved a highly technical interpretation of a Medicare national coverage determination that was the subject of strong disagreement in the medical community," Community Health Systems said. Ascension spokesman Nick Ragone said in a statement that Ascension was pleased to have reached an agreement with the Justice Department. “We are proud and appreciative of the cardiac care provided by our physicians, nurses and other caregivers nationwide to individuals in the communities we serve,” Ragone said." Read more a Modern Healthcare "Millennium Health LLC agreed to pay $256 million to resolve claims that it misrepresented the need for procedures and offered gifts to doctors in exchange for referrals.The biggest U.S. lab-testing company now plans to file for bankruptcy protection by Nov. 10, enabling it to turn over control of the business to its lenders, according to a person with knowledge of the matter.
The company has given the restructuring proposal to the holders of its $1.8 billion term loan and sent a copy to lawyers at the U.S. Department of Justice who are handling the settlement of the government’s case, said the person, who asked not to be named because the information isn’t public. Millennium will need to file its Chapter 11 petition with a bankruptcy court by Nov. 10, according to copies of resolved cases against the company that were unsealed Monday. The payment will resolve allegations that Millennium violated the False Claims Act by having doctors order unnecessary urine, drug and genetic testing, according to a U.S. Department of Justice statement on Monday. The government accuses Millennium, a provider of urine-testing services to monitor prescription drug use and potential abuse, of misrepresenting to doctors the necessity of an $1,800 genetic test for pain management patients." Read more at Bloomberg News 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 "BOB WACHTER: The U.S. health-care system is often criticized for its failure to innovate. With our costs far higher than those of any other developed country and our outcomes, on average, no better, such critiques are not unfounded.
However, over the past 20 years, a new specialty has developed that represents a substantial innovation. The story of this specialty–hospitalists–illustrates our great potential for innovation. As we consider all sorts of new innovations, from tele-visits, to precision medicine, to new delivery models such as accountable care organizations, it’s a story worth telling. The traditional model for hospital care in the U.S. was one in which a patient’s primary-care physician was expected to remain in charge of her care in the hospital. While this model seems to have much to recommend it–after all, who wouldn’t want to be cared for by their regular doctor when they’re really sick–in reality, it didn’t work very well. Primary-care physicians are extraordinarily busy in the office, so hospital patients often languished, or were cared for haphazardly by multiple specialists, with no one there to serve as the orchestra conductor. And it became increasingly difficult for primary-care physicians to keep up with new advances in both office practice and hospital medicine. As hospital care became faster paced and more expensive, the downsides of the traditional model became ever more evident. About 20 years ago, a new specialist emerged, which a colleague and I dubbed a “hospitalist” in an article in the New England Journal of Medicine. Hospitalists are generalist physicians who take on the role of managing a patient’s hospital care, returning the patient to his or her primary-care physician at the time of discharge." Read more at WSJ "For the last four years, Medicare has wielded a big stick: It has fined hospitals if too many of their patients returned to any hospital within weeks of being released.
But many safety-net hospitals, including academic teaching hospitals, say this is unfair because they take care of sicker, poorer patients. Now data released Monday shows they may be right. Researchers at Harvard Medical School found that hospitals are being penalized to a large extent based on the patients they serve. The researchers found that nearly two dozen variables, such as patients’ education, income and ability to bathe, dress and feed themselves, explain nearly half of the difference in readmission rates between the best- and worst-performing hospitals." Read more at The Washington Post "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 2015 Best Places to Work in Healthcare. Sutter Health Davis only California Hospital on the list.8/28/2015
Modern Healthcare has released its eighth annual list of 100 companies and organizations that have been named to its Best Places to Work in Healthcare for 2015. Modern Heathcare states "The recognition program, now in its eighth year, honors workplaces throughout the healthcare industry that empower their employees to provide patients and customers with the best possible care, products and services."
Sutter Health Davis is the only Hospital in California that made the list. Other workplaces in California on the list include: Bay Cities Health District in Redondo Beach, Grand Rounds in San Francisco, MedeAnalytics in Emeryville, Sutter Center for Psychiatry in Sacramento, TigerText in Santa Monica, and Triage Consulting Group in San Fransisco. See the list here at Modern Healthcare |
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