federal government

With FTC against deal, No. VA system gives up on acquisition

Mon, 09 Jun 2008 06:59:58 -0400

With the Federal Trade Commission coming out against the deal on antitrust grounds, Northern Virginia's five-hospital Inova Health System has given up on its plans to acquire Prince William Health System. The non-profit Inova system said it was giving up because the FTC challenge could easily have delayed the merger by as much as two years, a delay it apparently found unacceptable. In early May, the FTC filed an administrative complaint contending that adding Prince William Hospital would allow the Falls Church, VA-based Inova system to gain too much control of the region's hospital market, giving it enough leverage to force up managed-care reimbursement for inpatient services.

To learn more about the deal:
- read this Modern Healthcare article (reg. req.)

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Report: Antifraud compliance getting tougher for hospitals

Wed, 30 Apr 2008 06:59:57 -0400

A new report from the Deloitte Forensic Center argues that it's getting increasingly difficult for hospitals to comply with state and federal anti-fraud rules given the surge in new anti-fraud legislation. Laws and regulations designed to limit Medicare and Medicaid abuse have proliferated, while disclosure rules keep expanding, the consulting firm notes. Not only that, more regulation still may be in store. Regulators are paying increasingly close attention to relationships doctors have with hospitals and health systems, imaging centers, DME suppliers and other health professionals. For example, regulators recently began an information collection program that requires about 500 hospitals to file detailed reports on their contractual relationships with doctors.

To learn more about this issue:
- read this HFMA News item

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GA health system settles false claims suit for $5.1M

Fri, 25 Apr 2008 06:59:55 -0400

Savannah, GA-based Memorial Health has agreed to pay $5.1 million to settle a suit claiming that it made excessive payments to ophthalmologists. The suit, which was filed by a physician whistleblower, contended that the system's Memorial University Medical Center paid ophthalmologists at "levels which were not commercially reasonable," then billed for federal reimbursement for their services. The system, for its part, denies any wrongdoing and disputes the allegations contained in the suit, but needed to bring the matter to a close, executives said in a written statement.

To learn more about the suit:
- read this Modern Healthcare piece (reg. req.)

Genetic discrimination bill progressing in Congress

Thu, 24 Apr 2008 06:59:57 -0400

After more than a decade of attempts, it looks like Congress might finally pass a bill that would block health insurers from denying coverage to otherwise healthy persons based on their genetic predisposition to come down with a particular disease. The bill, the Genetic Information Nondiscrimination Act, also would bar employers from using genetic info as part of hiring, firing, job placement or promotions. The House approved the bill last year, and the Senate is expected to vote on it this week. The Senate version, however, attempts to make the bill easier on insurers. The changes are a concession to Sen. Tom Coburn (R-OK), who has blocked the bill, arguing that it could impose unintended liability risks.

If this bill passes, it could have important implications for the future of personalized medicine. Right now, some researchers studying gene-specific effects of treatments are finding that some subjects won't participate due to fears that their data will be used in just the fashion proscribed by this legislation.

To learn more about the bill:
- read this Modern Healthcare piece (reg. req.)

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GAO says gov't needs to create HAI prevention standards

Fri, 18 Apr 2008 06:59:55 -0400

A new report from the Government Accountability Office suggests that the federal government should step up to the plate and set standards for hospitals to follow in preventing hospital-acquired infections. Medicare and the CDC, in particular, should establish clear guidelines as to which infection-control practices they consider to be most important, the GAO said. The CDC, for example, strongly recommends that hospitals follow an imposing 500 practices, far more than hospitals can reasonably implement over the short term, hospital industry leaders say. The report also argues that federal regulators should do more to push hospitals to meet such standards, noting that private groups like doctors, hospitals and employers have done far more to nudge hospitals in that direction.

To learn more about the report:
- read this Baltimore Sun piece

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Healthcare industry top spender on federal lobbying in '07

Wed, 16 Apr 2008 06:59:56 -0400

It's good to get attention from federal legislators, but it's going to cost you. That's no mystery to some key healthcare groups, who collectively spent $445 million on federal lobbying during 2007, according to new research from the Center for Responsive Politics. That's more than any other sector of the economy, and tops on the list for the second year in a row, according to the CRP. This number includes 20 industry subsectors, including pharmaceutical and medical products companies ($227 million), health insurance companies ($138 million), hospitals and nursing homes ($91 million) and health professionals ($70 million.) Among those who follow lobbying, it will come as no surprise that leading spenders included the Pharmaceutical Research and Manufacturers of America ($22.1 million) and the American Medical Association (another $22.1 million).

To learn more about CRP's research on lobbying:
- read this Kaiser Daily Health Policy Report item

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FL doctor pays $7M to settle federal fraud suit

Wed, 16 Apr 2008 06:59:55 -0400

A physician who owns a Boca Raton, FL-based chain of medical imaging centers has agreed to pay $7 million to settle charges that he overcharged Medicare for services and ordered unnecessary tests. According to the settlement, radiologist Dr. Fred Steinberg overcharged Medicare for CT scans. The suit also charged that Steinberg illegally paid several local doctors to send him patients for imaging tests. Furthermore, it contended that his organization, University MRI and Diagnostic Imaging Centers, gave deep equipment and service discounts to local doctors, while hiring others as paid "medical directors" without requiring them to do any work. In the settlement, University MRI denied wrongdoing and said it settled to end the litigation process.

To learn more about the suit:
- read this South Florida Sun Sentinel piece

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Hospitals win back $666M from Medicare

Thu, 13 Mar 2008 07:59:58 -0400

In a deal that marks one of the largest settlements ever paid by the federal government to healthcare providers, CMS has agreed to pay out $666 million to 667 hospitals that sued for back payments. The dispute dates back to shifts in Medicare reimbursement policies from the 1980s. In 1986, the Reagan administration changed reimbursement rules to exclude some low-income patients from disproportionate-share payment calculations. A number of hospitals sued to have the rule changed, and succeeded in 1997. Following the reversal, one hospital sued for back payments for treatment in the 1990s, and eventually attracted a total of 667 hospitals seeking reimbursement as well--most of which were nonprofits treating largely the poor. The hospitals won in federal court, and the federal government lost its appeal, then got rejected for a hearing by the Supreme Court.

To learn more about the case:
- read this piece from The Wall Street Journal (sub. req.)
- read this Modern Healthcare article (reg. req.)

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ALSO NOTED: Cleveland Clinic spends big on lobbying feds; Seattle hospitals going green; and much more...

Tue, 11 Mar 2008 07:59:50 -0400

> When it comes to lobbying, the Cleveland Clinic does it up. The multispecialty medical center spent more than $1.36 million during 2007 alone to lobby the federal government. Article

> Increasingly, hospitals are working develop greener approaches to running their business. Here's how some Seattle hospitals are responding to this trend. Article

> Here's how one North Carolina health system is working to bring restful sleep to its ICUs. Article

> Despite the growth of the elderly population, the shortage of geriatricians continues to expand, partly due to the relatively low pay such specialists receive. Article

And Finally... Imagine having to face down a herd of wild elephants if you wanted to vote. Article

DOJ: CHS submitted $27.5M in bad claims

Mon, 25 Feb 2008 06:59:57 -0500

The U.S. Department of Justice already had let the world know that hospitals run by Community Health Systems had submitted improper claims. Now, the government has attached a number to CHS's alleged indiscretions. The DOJ now says that three of facilities run by the Franklin, TN-based hospital operator submitted a total of $27.5 million in improper claims to a New Mexico-based indigent care program. The DOJ says that because CHS submitted the improper claims, the state then in turn submitted false claims to the federal government. CHS, for its part, continues to deny that it submitted any false claims, and is in talks with the feds.

The news follows a disappointing quarter for CHS, which just announced that it lost $88.3 million during Q4 '07 on revenue of $3.53 billion. That's down from profit of $53.6 million $1.1 billion in revenue for the same quarter in 2006.

To learn more about the allegations:
- read this Modern Healthcare piece (reg. req.)

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NY overpays providers by $26M. Article
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