Thank God, You’re About To Be Treated By The Chief Transformation Officer!

You can’t believe your luck!

You’re in the back of an ambulance, its siren streaming as it pulls into the emergency entrance of Big Medical Center of Somewhere, America. You’re quickly rolled inside, in tremendous pain but still conscious. Up walks a physician in impeccable C-suite attire with a stethoscope draped over his neck.

God must be smiling on you, for you’re being taken care of by the highest-paid physician on the hospital’s payroll, yes, the top clinical integration/transformation executive!

What, you’re not lucky?

Hospitals are focusing their hard and few-earned dollars exactly where it counts, spending big bucks on the physician executives who will surely rescue them from nosocomial existential syndrome: chief officers of this or that trendy trend.

According to a recent report, here are the top earning lifesaving physician executives:

• Dr. Top Clinical Integration-Transformation Officer pulls in close to $600,000.
• Dr. Top Quality Executive earns a bit more than $460,000.
• Dr. Top Medical Informatics executive earns close to $380,000.

But don’t feel sorry for them having to spend so much time in meetings, drinking coffee, and having executive lunches. Those dollar figures are just the cash portion of their compensation.

Hey, I’d expect a lot of transformation for $600,000. Change is good, right? Just ask the physician I met from Venezuela. Oops.

Hundreds of hospitals are closing. Others left standing bemoan the fact that they’re broke and often blame it on their greedy contracted physician groups. “You want a stipend so that half your group doesn’t leave? What, are you crazy? We lost $4 million last year and now we have to hire a chief transformation officer and a few MDs who gave up medicine for informatics.”

Does anyone else find this funny? Does anyone else see this as not only rearranging the deck chairs on the post-iceberg Titanic, but spending to parachute in some extra caviar and champagne?

Still conscious as you’re rolled into the operating room and the team gathers around you (yes, you’re still awake . . . couldn’t afford those damn anesthesiologists) you’re baffled as the room gets dark, not light. And then you understand why: Dr. Top This-or-That wants to make sure that everyone can see her PowerPoint presentation, even you.

There’s never a shortage of money, only a question of priorities. And, it’s a heck of a question.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Alchemist Can’t Turn Outpatients Into Inpatients For Less Then $18.3 Million – Podcast

You know that I strongly believe that the future of hospitals isn’t hospitals, it’s outpatient facilities.

I’m not sure whether the folks at Banner Health read my book and (1) didn’t believe it, or (2) decided to prove me wrong, but either way it just cost them $18.3 million.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Allegations of Underpaid Debt Lands Big Healthcare Players in Whistleblower Hell – Medical Group Minute

When physicians think about allegations of kickbacks in the context of large insurers, it’s generally related to how a carrier’s internal “claims cops” have alleged that some physician or other provider engaged in a kickback scheme, obviating the payor’s need to pay claims, or, even worse, supporting their demand for repayment.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

If You’re Not Where You Thought You’d Be In Your Career, Watch This – Success in Motion Series

Ride along with Mark as he counsels you on telling yourself the truth about your current practice situation and finances, and suggests ways to break out of being a sacrificial animal for someone else’s benefit.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Hospital Chain Paying More than A Quarter BILLION Dollars to Resolve False Billing and Kickback Allegations

When my kids were small, we spent many a lazy Sunday afternoon watching monster versus monster movies, you know, like Godzilla versus Mothra.

Although today’s post doesn’t feature any Japanese creatures from Monster Island, it does feature a similar, two-monsters-in-one tale, drawing from, and compounding on, violations previously featured on the blog.

And, although Tokyo wasn’t destroyed, the U.S. government picked up close a quarter billion dollar settlement from the evil creature, oh, hospital company.

The first monster compounds on the crime of turning outpatient services into fraudulent inpatient claims. See my earlier post, Alchemist Can’t Turn Outpatients Into Inpatients For Less Then $18.3 Million.

The second monster is a chimera of sorts, a continuation of the “lay entity practices medicine via kickback and other pressure on physicians” undertow that pervades healthcare today. Although, to my knowledge, no one died. But see my previous post on this in which some are alleged to have been knocked off, Far Too “Friendly Physician” To Plead Guilty In $60 Million Healthcare Fraud. Will Murder Charges Follow?

Last week, the U.S. Department of Justice announced that Health Management Associates, LLC (HMA), formerly a U.S. hospital chain headquartered in Naples, Florida, will pay a total of over $260 million to resolve criminal charges and civil claims relating to an alleged scheme in which HMA knowingly billed government health care programs for inpatient services that should have been billed as outpatient or observation services, paid remuneration to physicians in return for patient referrals, and submitted inflated claims for emergency department facility fees.

According to admissions made in the resolution documents, in which HMA agrees to pay a $35 million monetary penalty in regard to criminal allegations, HMA instituted a formal and aggressive plan to improperly increase overall emergency department inpatient admissions at all HMA hospitals, including at Carlisle Regional Medical Center.

As part of the plan, HMA set mandatory company-wide admission rate benchmarks for patients presenting to HMA hospital emergency departments – a range of 15 to 20 percent for all patients presenting to the emergency department, depending on the HMA hospital, and 50 percent for patients 65 and older (i.e. Medicare beneficiaries) – solely to increase HMA revenue. HMA executives and HMA hospital administrators executed the scheme by pressuring, coercing and inducing physicians and medical directors to meet the mandatory admission rate benchmarks and admit patients who did not need impatient admission through a variety of means, including by threatening to fire physicians and medical directors if they did not increase the number of patients admitted.

HMA also agreed to pay $216 million as part of a related civil settlement. The civil settlement resolves several allegations:

  1. HMA’s liability for submitting false claims between 2008 and 2012 as part of its corporate-wide scheme to increase inpatient admissions of Medicare, Medicaid and the Department of Defense’s (DOD) TRICARE program beneficiaries over the age of 65. The government alleged that the inpatient admission of these beneficiaries was not medically necessary, and that the care needed by, and provided to, these beneficiaries should have been provided in a less costly outpatient or observation setting.
  2. That during the period from 2003 through 2011, two HMA hospitals in Florida, Charlotte Regional Medical Center and Peace River Medical Center, billed federal health care programs for services referred by physicians to whom HMA provided remuneration in return for patient referrals. To induce patient referrals, Charlotte Regional provided a local physician group with free office space and staff, as well as direct payments, which purportedly covered overhead and administrative costs incurred by the group for its management of a Charlotte Regional physician. HMA also provided another local physician with free rent and upgrades to his office space. HMA agreed to pay $93.5 million to resolve these civil allegations, with the United States receiving $87.96 million, and the State of Florida receiving $5.54 million.
  3. That two former HMA hospitals, Lancaster Regional Medical Center and Heart of Lancaster Medical Center in Pennsylvania, billed federal health care programs for services referred by physicians with whom the facilities had improper financial relationships. These relationships stemmed from HMA’s excessive payments to (1) a large physician group in return for two businesses owned by the group and for services allegedly performed by the group, and (2) a local surgeon that exceeded the value of the services provided. The government alleged that these arrangements were structured in this manner to disguise payments intended to induce the referral of patients. HMA agreed to pay $55 million to the United States to resolve these civil allegations.
  4. That Crossgates Hospital, an HMA facility in Brandon, Mississippi, leased space to a local physician from Jan. 15, 2005 through Jan. 14, 2007, but required the physician to pay rent for only half of the space he was actually occupying, in return for patient referrals to Crossgates Hospital. HMA agreed to pay $425,000 to the United States to resolve these civil allegations.
  5. That from September 2009 through December 2011, certain HMA hospitals submitted claims to Medicare and Medicaid seeking reimbursement for falsely inflated emergency department facility charges. HMA agreed to pay $12 million to resolve these civil allegations, with $11.028 million being paid to the United States and $972,000 being paid to participating states.

The allegations resolved by the settlement were originally brought in eight whistleblower lawsuits filed under the False Claims Act. One whistleblower will receive approximately $15 million as a share of the recovery, and two others were reported to be sharing approximately $12.4 million. Other whistleblower shares are to be determined.

The next time a hospital, ASC, or other facility tells you that the deal it proposes is valid and that its attorneys have vetted it:

(1) Remember HMA;

(2) Think again and for yourself; and

(3) Get your own advice on the compliance risk.

[Thank you, Jay, for brining the HMA settlement to my attention!]

 

Do You Know the Power of Questions? – Podcast

It was a Sunday. I was buying ties.

“Phone number, please?”

Those were the first words spoken by the saleswoman. A question.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

A Legal Alternative To Illegal Kickbacks To Physicians – Medical Group Minute Series

You can see why it’s so tempting for unscrupulous hospital CEOs to offer kickbacks to physicians.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

How To Avoid A $50 Million Lawsuit: Police The Application of Your Medical Group’s Policies – Success in Motion Series

Ride along with Mark as he counsels you on telling yourself the truth about your current practice situation and finances, and suggests ways to break out of being a sacrificial animal for someone else’s benefit.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

What You Need To Know About The High Cost Of 15 Minutes Of Fame, HIPAA Edition

Andy Warhol famously said, “in the future, everyone will be world-famous for 15 minutes.”

Well, a little bit more than 15 minutes of fame, television style, just cost three Boston area hospitals, Boston Medical Center, Brigham and Women’s Hospital, and Massachusetts General Hospital, a collective $999,000.

I Wanna Be on TV!

The $999,000, paid $100,000 by Boston Medical Center, $384,000 by Brigham and Women’s, and $515,000 by Massachusetts General, was required to settle charges brought by the U.S. Department of Health and Human Services, Office for Civil Rights that the hospitals compromised the privacy of patients’ protected health information (PHI) by inviting film crews on premises to film an ABC television network documentary series, without first obtaining authorization from patients.

Ah, the high cost of fame.

And to think, the administrators of those facilities could’ve avoided the mess if they themselves watched television news: In 2016, New York City’s New York-Presbyterian Hospital settled with OCR in connection with HIPAA violations related to the hospital’s “appearance” on ABC television’s “NY Med.” And that’s not fake news!

Lights, Action, HIPAA Violation!

Okay, I know you’re smarter than these geniuses. But it still pays to heed HIPAA requirements when allowing film crews and televised media onto your premises, whether it’s a hospital, ASC, or physicians’ office.

As the director of the Office of Civil Rights said when announcing the recent $999,000 settlement, “Patients in hospitals expect to encounter doctors and nurses when getting treatment, not film crews recording them at their most private and vulnerable moments. Hospitals must get authorization from patients before allowing strangers to have access to patients and their medical information.”

The same rules apply to you.

HHS has very specific guidance for facilities and physicians in connection with media access on your premises. Other than in some very limited circumstances, among other things, HIPAA-compliant authorizations are required from all affected patients, blurring out faces and disguising voices is completely ineffectual in preventing disclosure of PHI, and reasonable safeguards must be in place to protect against impermissible disclosures or to limit incidental disclosures of other PHI that may be in the area even if authorizations are obtained.

Hey, we all like publicity, but “free” publicity that costs you close to $1 million isn’t free, is it?

The bottom line: It pays to understand the limits of HIPAA and the media before you’re on the news . . . for being on the news.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com

Dr. Robot Will Cut You Now – Podcast

Back in the dark ages of medicine, I mean, in 2014, I wrote about competition from Dr. Nurses and Assistant Physicians. Now I’m writing about Dr. Robot. Same issue. Just on steroids.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.advisorylawgroup.com