Collection company president accused of stealing $1.6M from NYC hospital

http://www.beckershospitalreview.com/legal-regulatory-issues/collection-company-president-accused-of-stealing-1-6m-from-nyc-hospital.html

The president of Rockville Centre, N.Y.-based collection firm MBI Associates was arrested March 29 and charged with first-degree grand larceny for allegedly stealing $1.6 million from St. Barnabas Hospital in New York City, according to Rockville Centre Patch.

According to prosecutors, from Nov. 25, 2012, to Feb. 18, 2015, MBI Associates failed to give St. Barnabas Hospital $1.6 million the company had collected for services provided to the hospital’s patients. Norman Alpren, the 71-year-old president of MBI Associates, allegedly used the $1.6 million to cover operating expenses for his company, according to the report.

Mr. Alpren’s lawyer Robert Abiuso told Rock Centre Patch he expects his client to be “vindicated at trial.” If convicted, Mr. Alpren faces up to 25 years in prison.

Fee-for-Value: Is Your Revenue Cycle Ready?

http://www.healthleadersmedia.com/finance/fee-value-your-revenue-cycle-ready?spMailingID=10565023&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1120501013&spReportId=MTEyMDUwMTAxMwS2

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Healthcare organizations are adopting innovative practices as they prepare for a new future.

 

Lawyer sentenced to prison for stealing $1.2M in patient payments from St. Luke’s

http://www.beckershospitalreview.com/legal-regulatory-issues/lawyer-sentenced-to-prison-for-stealing-1-2m-in-patient-payments-from-st-luke-s.html

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Alan B. Gallas, 65, was sentenced Friday to one year and one day in federal prison for stealing more than $1.2 million from Kansas City, Mo.-based St. Luke’s Health System between 2009 and July 2015, according to the Department of Justice.

Mr. Gallas’ firm, Gallas & Schultz, collected past-due payments from patients for the hospital network. Money collected by the firm on behalf of St. Luke’s was supposed to go into a trust account. However, Mr. Gallas admitted in April that he had employees put holds on more than $1.2 million in St. Luke’s collections and then transfer the funds to the law firm’s operating account.

Mr. Gallas’ law partner Mark J. Schultz, 57, pleaded guilty Friday to participating in the fraud conspiracy. He admitted to transferring funds from the trust account to the law firm’s operating account. The total amount of funds diverted by Mr. Schultz will be determined by the court at his sentencing hearing, according to the DOJ. He faces up to five years in federal prison for his role in the scheme.

In addition to his prison term, Mr. Gallas was ordered to pay more than $1.2 million in restitution.

TeamHealth to pay $60 million to settle ‘upcoding’ claims as acquisition by Blackstone wraps up

http://www.healthcarefinancenews.com/news/teamhealth-pay-60-million-settle-upcoding-claims-acquisition-blackstone-wraps?mkt_tok=eyJpIjoiWmpKaE5ETXhZVGc0TkdJNSIsInQiOiJjWXBGUGRYOWwySVVDRnRsdjhpOTJEK09yNSt1dzcyN1d0TmNucCtzN1A4cWlVcGl2NmM3M1wvR0lYQjRUa3ZQdzd2b2g4ZnFQWFRlYVhBMFwvY3I2VFlJaEVkdXhlODhNSGk4VUpVempaVUloZVBmRjRtekZXQ1ZGYVdjNFRJdkZRIn0%3D

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.

Top 10 challenges facing physicians in 2017

http://medicaleconomics.modernmedicine.com/medical-economics/news/top-10-challenges-2017

2016 was a challenging year on many fronts for healthcare providers.

Physicians have just started to digest the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its changes to physician reimbursement. A long presidential election finally reached its conclusion, but the consequences of a Republican Congress and President-elect Donald J. Trump for U.S. doctors and patients remain unclear. And running a private practice did not get any easier. Balancing the need to deal with patients who won’t listen or won’t pay while also seeking positive patient satisfaction scores remains a daily struggle for many. 

These were just some of the challenges physician readers told Medical Economics they experienced this year and anticipate continuing for the foreseeable future. 

For the fourth consecutive year, Medical Economics reveals its list of obstacles physicians will face in the coming year and, more importantly, how to overcome them. For this latest presentation, we asked readers to tell us what challenges they face each day and where they needed solutions.

Here are their responses, starting with the biggest challenge of the coming year.

In Through the Out Door: A Comprehensive Look at Surprise Medical Bills

http://www.realclearhealth.com/articles/2017/01/09/in_through_the_out_door_a_comprehensive_look_at_surprise_medical_bills__110368.html?utm_source=RealClearHealth+Morning+Scan&utm_campaign=79f64f1189-EMAIL_CAMPAIGN_2017_01_09&utm_medium=email&utm_term=0_b4baf6b587-79f64f1189-84752421

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Imagine receiving medical care at an emergency department (ED) you know is in your insurance network only to find out later, after receiving a large medical bill, that the treating emergency physician was not an in-network provider in your health plan. Or diligently shopping for the best in-network hospital and in-network surgeon to perform an elective surgery, after which you find out that an out-of-network physician assisted in the procedure and expects payment for the portion of her bill not covered by your insurance. Imagine needing an ambulance, only to find out there are no ambulances available in your area that are covered by your insurance.

9 ways hospitals can reduce debt

http://www.healthcaredive.com/news/9-ways-hospitals-can-reduce-debt/430488/

Healthcare reform has had a dramatic impact on hospital reimbursement. While millions of Americans are now insured under the Affordable Care Act, high-deductible health plans can leave patients cash-strapped after expensive episodes of care. Sometimes, patients can’t pay for the services they receive, pushing up bad debt at hospitals. At the same time, hospitals are dealing with lower reimbursements and a shift from inpatient to outpatient care, leaving some with property and beds that are no longer financially productive.

Take Community Health Systems for example. Burdened with $15 billion in debt , the Franklin, TN-based hospital chain sold a four-hospital joint venture and spun off 38 hospitals into a separate entity, Quorum Health Corp., earlier this year. Recently, the system inked deals to sell an additional 17 hospitals.

According to Patrick Pilch, head of BDO Consulting’s healthcare advisory practice, many hospitals and health systems don’t have a complete handle on what their costs of care are and they’re losing money as a result. “Understanding your costs of care as well as your cost of capital is imperative,” he tells Healthcare Dive. “Then align that to a future strategy. That’s where you’re going to pull your way out of debt.”

Hospitals should look at their assets, business plan, market and supply chain and then see how those align with their capital strategy, Pilch says. With interest rates expected to rise, non-investment grade hospitals will have a harder time getting capital. “If you have a lot of capital that’s not performing well, you’re in a bit of a state right now,” he adds.

Here are nine ways hospitals can work on debt:

3 ways hospitals must prepare for a likely recession

http://www.fiercehealthcare.com/healthcare/3-ways-hospitals-must-prepare-for-a-likely-recession?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTmpjd1pURm1NR0ZqTlRWbSIsInQiOiI5MkdaMWJlaGV4dlppeWNkY1NqNTNtTFJ1MFlrcWtQQWxcL2hvYWVUK3lmNEJRT1lCVTJLQTFwdGFcL0dLWWlGMnBzbGNQbXhDdnFDVUdsdkthR3Y4UzJIVm5sT25iNHJmYWd2aGlFXC9ycVNDST0ifQ%3D%3D

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Bad economic times are coming, says Jeff Goldsmith, Ph.D.

The U.S. is in the 89th month of an economic recovery–among the longest since World War II–which means a recession is overdue and healthcare organizations should prepare now, writes Goldsmith, a national adviser to Navigant Healthcare, in Hospitals & Health Networks.

Healthcare systems can get ready for that inevitable economic downturn by taking the following steps:

Look for ways to do more with less. Healthcare organizations can expect to live with slow or shrinking revenues. Scrutinize physician compensation and productivity. Reduce layers of management and examine contracts for supplies and services.

Tighten up revenue cycle functions.  Improve your patient collections process. Make payment obligations clear to patients and ensure that billing staff keep better track of denied claims from insurance companies.

Fight for health policies that work for healthcare organizations. Lobby members of Congress, state legislators and governors to protect Medicaid funding. “Hospitals must insist that policymakers keep their commitments when times are tough,” Goldsmith says.

ICD-10 turns 1: Was it so bad?

http://www.healthcaredive.com/news/icd-10-turns-1-was-it-so-bad/427115/

R51: headache. Gearing up for the switch from ICD-9 to ICD-10 last October, many providers expected nothing but headaches. The new system increased the number of diagnostic codes from around 13,000 to about 68,000, requiring clinicians to sift through highly specified conditions — and some unusual ones, such as W61-62XD: struck by duck.

But after a year of using the ICD-10 — and the impending end of a one-year grace period that ensured providers wouldn’t be denied Medicare Part B claims as long as they used a code from the correct family — most physicians say the implementation process went better than expected.

“The fear that this was really going to impact us financially because of the potential inability to process the new codes really never transpired,” says Michael Munger, a family physician with Saint Luke’s Medical Group in Overland Park, KS, and president-elect of the American Academy of Family Physicians.

In fact, the error rate for claims tracked by the AAFP was the same this year as it was for ICD-9 — 10%. The fact that commercial insurers didn’t have the grace period bodes well for the loss of flexibilities, since doctors should be used to being more specified in their claims.

Black Book Rankings: 25 top RCM outsourcing vendors

http://www.beckershospitalreview.com/finance/black-book-rankings-25-top-rcm-outsourcing-vendors.html

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Black Book Rankings has released its 2016 rankings of financial and revenue cycle management systems and services.

Here are the top five vendors included in the rankings across five different outsourcing categories.