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TeamHealth to pay $60 million to settle ‘upcoding’ claims as acquisition by Blackstone wraps up
DOJ alleged that subsidiary IPC pressured physicians to bill for higher levels of service than what was provided.
TeamHealth Holdings, nationwide hospital staffing provider and owner of group practice IPC Healthcare, has agreed to pay $60 million plus interest to settle allegations that IPC engaged in a prolonged scheme of billing Medicare, Medicaid, the Defense Health Agency and the Federal Employees Health Benefits Program for more expensive medical services that were actually provided, the Department of Justice announced.
TeamHealth is comprised of more than 20,000 affiliated physicians and advanced practice clinicians, and offers outsourced emergency medicine, hospital medicine, critical care, anesthesiology, orthopedic hospitalist, acute care surgery, obstetrics and gynecology hospitalist, and other services to approximately 3,300 acute and post-acute facilities and physician groups across the country.
According to the DOJ, the government alleged that IPC put corporate pressure on physicians to “upcode” claims to maximize billing, especially pressuring physicians with lower billing levels.
TeamHealth also agreed to increase accountability and transparency in order to avoid any future fraud, according to the settlement.
The allegations stem from a whistleblower lawsuit filed in a Chicago federal court by Bijan Oughatiyan, a physician formerly employed by IPC as a hospitalist. Under the False Claims Act, the government was allowed to intervene and take over the suit, as it did in this case. Oughatiyan will receive about $11.4 million, which is his share of the recovery as allowed under the False Claims Act.
The acquisition of TeamHealth by funds affiliated with global asset manager Blackstone and certain other investors, wrapped up Monday, making TeamHealth a privately held company.
Aetna, UnitedHealth show increasing appetite for value-based care contracts
Aetna has long held a goal to reach 75 to 80 percent of its medical spend in value-based relationships by 2020.
The biggest health insurers are moving quickly towards to value-based care arrangements, their recent earnings reports show.
While Aetna has long-held a goal to reach 75 to 80 percent of its medical spend in value-based relationships by 2020, Aetna’s medical spend is now 45 percent tied to value, CEO Mark Bertolini said during last week’s fourth quarter earnings call.
“One way we measure our success is by how well we are able to keep our members out of the hospital and in their homes and communities,” Bertolini said. “For example, in 2016, we reduced total acute admissions by approximately 4 percent, and we deployed predictive modeling to target members at the greatest risk of readmission.”
Aetna has achieved a 27 percent reduction in readmission rates using multidisciplinary care teams that engage facilities to develop effective discharge plans, he said.
“Collectively, these clinical programs have driven a best-in-class Stars readmission rate among national competitors,” he said.
Aetna sees more opportunities for reducing utilization over the long-term in readmission rates, and in a reduction in inpatient days. Unit price is still the driver in value-based purchasing, Bertolini said.
“I think value-based contracting is going to continue to be encouraged by even the current administration as a way of getting a handle on healthcare costs,” he said. “We have a healthy pipeline of opportunities. They will not all be joint ventures. I think there are other models emerging.”
UnitedHealthcare is increasingly helping states manage care for their complex, vulnerable and most costly populations, as well as assisting employers with programs to support the needs of retirees and employees with chronic conditions, according to CEO Stephen Hemsley in the insurer’s earnings report.
50 healthcare organizations dubbed best in supply chain by GHX
Systems recognized for their work in improving operational performance and driving down costs through automation.
Global Healthcare Exchange has announced its annual list of the healthcare provider organizations being recognized as the 2016 GHX “Best 50” Supply Chains in North America.
The supply chains are being recognized for their work in improving operational performance and driving down costs through automation. The recipients will be honored at the 17th annual Healthcare Supply Chain Summit from April 24-26 at the Gaylord National Resort in National Harbor, Maryland.
The list, alphabetically, is as follows:
Steven Brill breaks down how much top hospital CEOs make per patient stay
Hospital CEOs netting even just a few dollars in earnings per patient day often haul in considerable salaries, lawyer and journalist Steven Brill claims in new research published in Axios on Tuesday.
To examine the relationship between patient days and executive salary, Brill merged American Hospital Directory data about hospital operations, including patient beds and total patient days, with IRS information on what nonprofit hospitals pay their top brass.
The result is a list of the reported annual payouts to the CEOs of the 20 largest hospital systems, ranked by the number of hospitals in the system, divided by the annual number of patient days recorded at each hospital.
In other words, the research shows how much these CEOs got paid for each day a person spends in their hospital.
Hospitals add $2.8 trillion to US economy, AHA report says
http://www.healthcarefinancenews.com/news/hospitals-add-28-trillion-us-economy-aha-report-says
American Hospital Association estimates that each hospital job supports about two additional jobs.
Hospitals support 16 million total jobs, or one in nine jobs in the United States, according to an annual survey from the American Hospital Association. They also support more than $2.8 trillion in economic activity.
Those numbers don’t reflect direct hospital employment, but rather the “ripple effect” the AHA said hospitals exert across the broader economy. Directly, hospitals employ about 5.7 million people. That’s good enough to make them one of the top sources of private sector jobs, according to the AHA.
The group calculated the ripple effect by factoring in the $852 billion that hospitals spend on goods and services from other businesses. The AHA estimates that each hospital job supports about two additional jobs, and every dollar spent by a hospital supports roughly $2.30 of additional business activity.
According to figures from the Bureau of Labor Statistics, healthcare added more than 35,000 jobs per month in 2016. In 2015, hospitals treated 142 million people in their emergency departments, provided 581 million outpatient visits, performed close to 27 million surgeries and delivered nearly 4 million babies, the AHA said.
The healthcare industry added about 18,300 jobs last month.
Consensus builds that GOP will keep value-based focus for healthcare reimbursement
Health Affairs report suggests new HHS leadership should expand state all-payer models, fine-tune accountable care organizations.
Another report suggest value-based payment models will continue even, if in a different form, under the new administration’s governance of the U.S. Department of Health and Human Services, according to a Health Affairs report.
“The election of Donald Trump might change the strategy of advancing healthcare reform, but the movement toward value-based care both preceded the Affordable Care Act and has bipartisan support,” the authors said.
If Tom Price is confirmed as secretary and Seema Verma administrator of the Centers for Medicare and Medicaid Services Administrator, the agencies will support new value-based payment models said authors David Muhlestein, Natalie Burton and Lia Winfield.
But Price has already voiced his opposition to mandatory models such as bundled payments.
CMS, which has 74 healthcare initiatives and programs in different stages of research, testing, and adoption, recently proposed to make its cardiac care bundle mandatory and said opportunities exist for bundles that consider multiple chronic conditions.
While payment innovation may continue, the agency needs to articulate its overall strategy in four focus areas, the authors said.
The first is the expansion of the population-based model and disease-specific model.
