27
HEALTHCARE
NEWS
DaVita Medical will pay $270M to resolve False
Claims Act violation allegations: 5 things to know
By Laura Dyrda
D
aVita Medical Holdings will pay $270
million to resolve False Claims Act
violation allegations related to inac-
curate billing information that led to inflated
payments from Medicare Advantage Plan
beneficiaries.
Here are five things to know:
1. DaVita operated a Medicare Service
Organization that contracted with Medicare
Advantage Organizations in California,
Nevada and Florida, as well as other states
nationwide. DaVita collected and submit-
ted diagnoses to the MAOs and received a
share of the payments from CMS for their
beneficiaries.
2. As part of a voluntary disclosure to the
government, DaVita revealed an indepen-
dent physician association it acquired in
2012 submitted inaccurate diagnosis codes
to CMS and received inflated payments as a
result. e IPA, HealthCare Partners, shared
in the payments along with DaVita.
3. HealthCare Partners circulated improp-
er medical coding guidance, according to
the Department of Justice report, that led
to physicians using improper diagnosis
codes for procedures. In one example, phy-
sicians used an improper code for spinal
condition treatment that increased CMS
reimbursement.
Due to self-disclosures and DaVita's coop-
eration with the government investigation,
the U.S. agreed to a "favorable resolution of
potential claims arising from this conduct."
4. DaVita agreed to pay $270 million
which settles whistleblower allega-
tions, alleging HealthCare Partners was
involved in "one-way" chart reviews,
searching medical records for diagno-
ses that providers may have "missed"
and then submitting them to MAOs for
increased Medicare payments. The al-
legations also accuse the IPA of leaving
inaccurate diagnosis codes in submitted
claims that should have been deleted.
5. e whistleblower for the "one-way" chart
review allegations, who was a former MAO
employee that did business with DaVita,
received about $10.2 million of the settle-
ment. n
Physician pay, productivity
slows for first time in a
decade: 5 report statistics
By Rachel Popa
A
n American Medical Group Association re-
port found physician compensation and produc-
tivity did not experience a meaningful increase
in 2017.
AMGA recorded responses from 270 multispecialty
medical groups, representing 105,000 clinical provid-
ers in its AMGA 2018 Medical Group Compensation
and Productivity Survey.
Here are the key details to know:
1. The weighted average change in median compensa-
tion for all physician specialties was an increase of 1.2
percent.
2. The weighted average change in median physician
productivity was negative 1.63 percent.
3. Cardiac/thoracic surgery saw the largest pay increase
at 6.4 percent.
4. The next highest increase was emergency medicine
at 1 percent.
5. The report said possible reasons for the decrease in
productivity may be burdensome EHR use, as well as
administrative and compliance requirements. n
Walmart may add health clinics
in its parking lots
By Ayla Ellison
W
almart stores in several states are transform-
ing extra parking lot space into "town centers,"
some of which could include health clinics, ac-
cording to Business Insider.
"The Walmart Town Center concept is an exciting approach
to how we serve our customers by moving beyond the
store's four walls and reimagining how we use our unique
assets — our existing stores and the surrounding land — to
transform how customers experience Walmart," a Walmart
spokesperson told Business Insider.
Walmart provided details about a few of the new hubs on
a website established for the projects. The Atlanta Business
Chronicle reports Walmart is evaluating whether to add
health clinics in some of the new "town centers."
"We envision a more robust and dynamic shopping experi-
ence that combines entertainment venues, curated local
food vendors, health and fitness services as well as recre-
ational opportunities in a way that connects and engages
with the community," a Walmart spokesperson told Busi-
ness Insider.
Walmart has established its position as a one-stop shop,
but the retailer may be redefining what that means by sur-
rounding its stores with a variety of complementary tenants,
according to the report. n
