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Category Archives: Management
Cleveland Clinic-owned hospital system pays $21M to settle False Claims allegations
Dive Brief:
- A Cleveland Clinic-owned hospital system in Akron, Ohio, is paying the federal government $21.3 million to settle claims it illegally billed the Medicare program.
- Akron General Health System allegedly overpaid physicians well above market value for referring physicians to the system, violating the Anti-Kickback Statute and Physician Self-Referral Law, and then billed Medicare for the improperly referred business, violating the False Claims Act, between August 2010 and March 2016.
- Along with an AGHS whistleblower, the Cleveland Clinic Foundation, which acquired the system at the end of 2015, voluntarily disclosed to the federal government its concerns with the compensation arrangements, which were enacted by AGHS’ prior leadership, the Department of Justice said Friday.
Dive Insight:
The Anti-Kickback Statute forbids providers from paying for or otherwise soliciting other parties to get them to refer patients covered by federal programs like Medicare, while the Physician Self-Referral Law, otherwise known as the Stark Law, prohibits a hospital from billing for those services. Despite the laws and a bevy of other regulations resulting in a barrage of DOJ lawsuits and been a thorn in the side of providers for decades, fraud is still rampant in healthcare.
Of the more than $3 billion recovered by the government in 2019 from fraud and false claims, almost 90% involved the healthcare industry, according to DOJ data.
“Physicians must make referrals and other medical decisions based on what is best for patients, not to serve profit-boosting business arrangements,” HHS Office of Inspector General Special Agent in Charge Lamont Pugh said in a statement on the AGHS settlement.
Cleveland Clinic struck a deal with AGHS in 2014, agreeing to pay $100 million for minority ownership in the system. The agreement gave the clinic the option to fully acquire AGHS after a year, which it exercised as soon as that period expired in August 2015.
The settlement stems from a whistleblower suit brought by AGHS’s former Director of Internal Audit Beverly Brouse, who will receive a portion of the settlement, the DOJ said. The False Claims Act allows whistleblowers to share in the proceeds of a suit.
As fraud has increased in healthcare over the past decade — the DOJ reported 247 new matters for potential investigation in 2000, 427 in 2010 and 505 in 2019 — the federal government has renewed its efforts to crack down on illegal schemes. That’s resulted in the formation of groups like the Medicare Fraud Strike Force in 2007 and the Opioid Fraud and Abuse Detection Unit in 2017, which has in turn resulted in the DOJ recovering huge sums in stings, settlements and guilty verdicts.
Some of the biggest settlements reach into the hundreds of millions, and involve billions in false claims.
In 2018, DOJ charged more than 600 people for falsely billing federal programs more than $2 billion; last year federal agencies charged almost 350 people for submitting more than $6 billion in false claims. That last case led to creation of a rapid response strike force to investigate fraud involving major providers in multiple geographies.
Other large settlements include Walgreens’ $270 million fine in 2019 to settle lawsuits accusing the pharmacy giant of improperly billing Medicare and Medicaid for drug reimbursements; hospital operator UHS’ $122 million settlement last summer finalizing a fraudulent billing case with the DOJ after being accused of fraudulently billing Medicare and Medicaid for services at its behavioral healthcare facilities; and West Virginia’s oldest hospital, nonprofit Wheeling Hospital, agreeing in September to pay $50 million to settle allegations it systematically violated the laws against physician kickbacks, improper referrals and false billing.
EHR vendor eClinicalWorks paid $155 million to settle False Claims Act allegations around misrepresentation of software capabilities in 2017, while Florida-based EHR vendor Greenway Health was hit with a $57.3 million fine in 2019 to to settle allegations the vendor caused users to submit false claims to the EHR Incentives Program.
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These are the 5 traits that set extraordinary people apart, says former FBI agent—‘but you need the entire set’
What makes someone extraordinary? As a retired FBI agent with more than 40 years of studying human behavior and performance, no question has captivated me more.
Extraordinary people have a wisdom and way of being that inspires and commands respect. They energize you with their wisdom and empathy. You want them to be your friend, neighbor, co-worker, manager, mentor or community leader.
The 5 traits of extraordinary people
Surprisingly, the qualities that make these people stand out aren’t related to their level of education, income or talents (say, in athletics or art or business).
As it turns out, based on thousands of observations, there are five traits that set exceptional individuals apart from everyone else — but you must have the entire set, and not just one or a few.
I call them “The Five Domains of Exceptional People”:
1. Self-mastery
Self-mastery brings out your best in whatever you do through dedication, curiosity and adaptability.
Usain Bolt, the fastest human to ever live, didn’t achieve that status merely through athletic ability. He achieved it through self-mastery: He learned, sacrificed, worked hard and remained diligently focused. Michael Jordan, the greatest basketball player of all time, did the same.
But another side to self-mastery is knowing our emotions, strengths and, more importantly, our weaknesses. By understanding ourselves, we know things like when others should take the lead, when today is not our day or when we need to confront our demons.
Start attaining self-mastery by asking:
- What areas need attention?
- What knowledge, training or skills will help me pursue my goals?
- What can I do now to initiate change?
- How can I better myself through books, mentors, organizations, video tutorials or online classes?
2. Observation
We’re taught to look, but not to observe. We look to see if we can cross the street safely or what supermarket line is moving the fastest. It’s a passive experience that’s useful, but may not provide complete information.
Observing, on the other hand, is active; it requires effort, but the results are more enlightening. It’s about using all our senses to decode the world in real time for a more informed understanding of our environment and of others.
By working as an FBI agent and as an ethologist, I’ve developed my sensitivity for reading the needs, wants, desires, concerns and preferences of others — all crucial information for understanding and communicating with people.
The most observational people have a skill set that many lack. They instantly know:
- What they are seeking and whether there may be multiple explanations.
- How context and/or culture factors in.
- How they can validate their observations and conclusions.
- How to prioritize, separating the inconsequential from the essential.
3. Communication
We communicate constantly. Do it right and people will adore you. Do it wrong and you create doubt, indifference, even anger.
Exceptional communication skills elevate the quality of your relationships. It’s not about communicating perfectly, but rather effectively — and that builds trust. Here’s how:
- Address emotions first. We cannot think or communicate clearly until emotions are dealt with. This is where reading body language is helpful.
- Build rapport through caring and kindness. It can be verbal or nonverbal: a wave or an outstretched hand to acknowledge or welcome. Mirroring your companion’s gestures goes far.
- Be prompt. Answering emails and calls promptly shows that you value others. Bad news shouldn’t be delayed, nor should gratitude and affirmation.
- Listen to validate. Listen not only for what is said, but also in what order and how often certain words are mentioned. Repetition of a topic, for example, can shed light on unresolved or underlying problems.
4. Action
Our actions are the nonverbals that show who we are, what’s important to us and how we feel about others.
You can’t fully master this trait without the previous three: Self-mastery prepares us for possible actions to take based on what’s happening; observation allows us to understand the situation in context so we can act appropriately; communication allows us to give and receive the information and support to act.
Exceptional individuals weigh four major factors when making decisions:
- Do my actions build trust?
- Do my actions add value?
- Do my actions positively influence or inspire?
- Do my actions benefit others?
5. Psychological Comfort
Psychological comfort is a state where our biological and emotional needs and preferences are met.
It forms the bedrock of our mental and physical health, driving everything from our relationship choices to the brands we buy. We thrive when we have psychological comfort, and it’s especially essential in difficult times.
Since we’re primed to receive psychological comfort, it doesn’t take a grand gesture — it just takes the right one. It could be a calm voice, a kind word, an acknowledgment, a thank you note, a welcoming smile or suggesting a break.
Psychological comfort is where self-mastery, observation, communication and action join forces, helping you recognize and provide what best reduces unwanted emotions like stress, fear or apprehension.
It’s simple: In the 21st century, whoever provides the most psychological comfort wins.
Thought of the Day on Knowledge
Cartoon – The Meeting Agenda
HENRY KOTULA 