Chinese investor Tianqiao Chen and his group of companies have a 12.2 percent stake in Franklin, Tenn.-based Community Health Systems after selling nearly 13 million shares of the company in the past month, according to Securities and Exchange Commission filings.
Mr. Chen and his Shanda Group company affiliates sold 3.4 million shares of CHS on Dec. 14 for between $8.50 and $8.71 per share, bringing in a total of $28.5 million. The move comes after he sold 5 million shares of CHS from Nov. 10-12 and another 4.6 million shares Nov. 23. Those sales brought in a total of $81.2 million.
Mr. Chen, a pioneer in China’s online gaming industry, began buying up shares of CHS in 2016. The last public comment the investor made about CHS was in 2018, when Shanda Group said it had a “good relationship” with CHS and supported the company’s strategy and management team.
Hospital margins and revenues continued to fall in November, while expenses remained above 2019 levels, according to Kaufman Hall’s December Flash report, which examines metrics from the previous month.
The median hospital operating margin in November was 2.5 percent year to date with funding from the Coronavirus Aid, Relief and Economic Security Act. Without the funds, the median hospital operating margin narrowed to -1.1 percent.
Skyrocketing COVID-19 cases are already stretching hospitals’ capacity, and Kaufman Hall expects the situation to worsen in coming months as holiday gatherings and colder weather push case counts up even further.
President Donald Trump commuted a 20-year sentence for a Florida healthcare executive who was convicted for his role in a $1.3 billion Medicare fraud case. It was the largest healthcare fraud scheme ever charged by the U.S. Justice Department.
In April 2019, Philip Esformes, who operated a network of more than 30 skilled nursing homes and assisted living facilities in Florida, was found guilty of 20 charges, including paying and receiving kickbacks, money laundering and bribery, according to the Department of Justice. He was sentenced to 20 years in prison and ordered to pay $44.2 million in forfeiture and restitution. The commutation doesn’t overturn the restitution order.
Mr. Esformes was among several people President Trump granted a full pardon or commutation of all or some of their sentences. In a Dec. 22 news release, the White House said Mr. Esformes is in declining health.
The owners of more than a dozen pharmacies in New York City and Long Island have been arrested and charged for their roles in an alleged $30 million healthcare fraud and money laundering scheme, the Department of Justice announced Dec. 21.
Peter Khaim and Arkadiy Khaimov are accused of submitting fraudulent claims for expensive cancer drugs by exploiting emergency codes and edits in the Medicare system that went into effect due to the COVID-19 pandemic. The drugs were allegedly never provided, ordered or authorized by a medical professional.
Mr. Khaim and Mr. Khaimov allegedly used COVID-19 emergency override billing codes to submit fraudulent claims to Medicare for cancer medication Targretin Gel 1%. The medication has an average wholesale price of about $34,000 for each 60 gram tube, according to the Justice Department.
Prosecutors charged Mr. Khaim and Mr. Khaimov with conspiracy to commit healthcare fraud and wire fraud, conspiracy to commit money laundering and aggravated identity theft, according to the Justice Department. Mr. Khaimov was separately charged with concealment of money laundering.
A Florida man filed a class-action lawsuit against Aetna Life Insurance Co., claiming it systematically denied coverage for a cancer treatment called proton beam radiation therapy, according to court documents.
The lawsuit, which has been moved to the District Court for the Middle District of Florida, was filed by Scott Lake. Mr. Lake claims Aetna wrongfully denied coverage for proton beam radiation therapy to treat his prostate cancer. The denial, which deemed the treatment experimental, came despite recommendations from oncologists, he claims.
While some insurers have begun covering proton beam radiation therapy for certain cancers — for example, Medicare generally covers the treatment — it is not uniform across the commercial insurance industry. In 2019, UnitedHealthcare found itself in court over its denial of coverage to one of its members who also sought the treatment for prostate cancer.
Aetna’s proton beam radiotherapy policy, last updated in November, outlines when the insurer considers the treatment medically necessary. In the bulletin, Aetna said it considers proton beam radiotherapy “experimental and investigational” for prostate cancer in adults over age 21 “because its effectiveness for these indications has not been established.”
Becker’s reached out to Aetna for comment on this lawsuit. This article will be updated as more information becomes available.
There were several hospital mergers that, at some point in their lifetime, were called off in the past year.
Below are seven hospital mergers called off since December 2019, beginning with the most recent:
1. Sanford, Intermountain halt merger talks Sanford Health indefinitely suspended discussions in early December about a planned merger with Salt Lake City-based Intermountain Health because of the abrupt exit of Sanford’s longtime president and CEO, Kelby Krabbenhoft. Sanford and Intermountain announced in October they had signed a letter of intent to merge, with completion of the deal expected in 2021. The combination would create a $15 billion, 70-hospital system. In its statement issued Dec. 4, Sanford said it will pause current merger and acquisition activity while it addresses other organizational needs.
2. Advocate Aurora, Beaumont cancel merger Advocate Aurora Health, which has dual headquarters in Milwaukee and Downers Grove, Ill., and Southfield, Mich.-based Beaumont Health called off their merger plan Oct. 2, about five months after signing a letter of intent to combine. The proposed merger faced criticism from some Beaumont physicians, nurses and donors. In August, the Beaumont board of trustees confirmed it would delay a vote on the planned merger. The trustees decided to postpone the vote after seeing the results of a survey, completed by 1,500 of the system’s 5,000 physicians, that revealed a lack of confidence in Beaumont’s leadership and concerns about its proposed merger with Advocate Aurora. The merger of Beaumont and Advocate Aurora would have created a $17 billion system with 36 hospitals.
3. California hospital ends merger talks with Dignity Health County officials overseeing Ventura (Calif.) County Medical Center ended merger talks with San Francisco-based Dignity Health in July after leaders from both parties deemed an affiliation too risky. County Health Care Agency Director Bill Foley said Dignity officials considered it a risk to take on public hospitals, while county managers were concerned they would give up control but still face risk for buildings and finances. County officials were also concerned VCMC would lose its designation as a public hospital under either a lease or a contract with Dignity, which would put roughly $150 million in annual funding at risk.
4. Beaumont, Summa Health cancel $6.1B merger plan Southfield, Mich.-based Beaumont Health called off a proposed merger with Akron, Ohio-based Summa Health in late May. They ended talks about five months after signing a definitive agreement, under which Summa Health would have become a subsidiary of Beaumont. The proposed deal, which had already received all necessary regulatory approvals, would have created a nonprofit system with 12 hospitals and $6.1 billion in annual revenue.
5. 4 Chicago hospitals call off $1.1B merger plan Chicago-based Advocate Trinity Hospital, Mercy Hospital and Medical Center, South Shore Hospital and St. Bernard Hospital signed a letter of intent in January to combine into a single health system and build at least one new hospital and several community health centers. The hospitals called off the deal in late May after government funding for the $1.1 billion plan fell through.
6. Geisinger, AtlantiCare sever merger Danville, Pa.-based Geisinger and Atlantic City, N.J.-based AtlantiCare severed their merger in March, about five years after the two systems combined. The separation of the two organizations is expected to take up to 18 months, the two organizations said in March.
7. Wisconsin health systems call off merger La Crosse, Wis.-based Gundersen Health System and Marshfield (Wis.) Clinic Health System abandoned plans in December 2019 to merge into a 13-hospital rural healthcare network. The two systems said they “mutually decided to remain independent” after several months of productive and collaborative discussions.
HENRY KOTULA 