Becker's Hospital Review

52 POPULATION HEALTH 52 CEO/STRATEGY Intermountain: Whistle-blower provisions of False Claims Act are unconstitutional By Ayla Ellison S alt Lake City-based Intermountain Healthcare ar- gues the False Claims Act's whistle-blower pro- visions are unconstitutional in a petition asking the U.S. Supreme Court to review a case, according to e National Law Review. Five things to know: 1. e case was filed in 2012 under the qui tam, or whis- tle-blower, provisions of the False Claims Act. It alleges Intermountain submitted false claims for medically unnec- essary heart procedures performed by a cardiologist at two of its hospitals. 2. e federal government declined to intervene in the case, and the district court granted Intermountain's motion to dismiss the complaint. e district court held that the whis- tle-blower failed to show that the defendants "knowingly made an objectively false representation to the government that caused the government to remit payment" for the pro- cedures at issue, according to the report. 3. e whistle-blower appealed the decision, and the Court of Appeals for the 10th Circuit reversed the dismissal. e appellate court acknowledged the whistle-blower is re- quired to allege "the who, what, when, where and how of the alleged claims," but the court excused certain deficiencies in the whistle-blower's pleadings. e court said the deficien- cies were caused by the whistle-blower's "inability to obtain information within the defendant's exclusive control." 4. Intermountain is now asking the Supreme Court to weigh in on two issues. First, the health system is asking the Supreme Court to resolve a split between the circuits over a Federal Rule of Civil Procedure that requires fraud lawsuits to include specific allegations of fraud. Second, Intermountain is asking the Supreme Court to examine whether the qui tam provisions of the False Claims Act are constitutional. 5. Intermountain argued that the qui tam provisions of the False Claims Act are unconstitutional because they allow whistle-blowers to act as prosecutors beyond the control of the executive branch. e health system asked the Supreme Court to revisit its decision in Vermont Agency of Natural Resources v. Steven, issued in 2000. In that decision, the Supreme Court declined to weigh in on whether whistle-blower suits violate the Appointments Clause of Article II of the Constitution. n Mission Health CEO to become strategic adviser for new parent HCA By Anuja Vaidya R onald A. Paulus, MD, president and CEO of Asheville, N.C.-based Mission Health, is leaving to take on a new role with Nashville, Tenn.-based HCA Healthcare, according to a Citizen Times report. Dr. Paulus will serve as a strategic adviser for HCA, which final- ized its purchase of the six-hospital Mission Health for approxi- mately $1.5 billion. In an email to Mission staff obtained by the Citizen Times, Dr. Paulus said that as strategic adviser, he will focus on Mission's integration into HCA as well as on improving access to care. He said in the email that with the HCA deal, "we have set the foun- dation for a remarkable future, both for the health system and for the region," according to the report. Dr. Paulus assumed the top post at Mission Health in September 2010. Prior to that, he was executive vice president of clinical operations at Danville, Pa.-based Geisinger Health System. He was also co-founder and president of CareScience, a care man- agement service provider that was acquired by Premier. Dr. Paulus also noted in his email that HCA will appoint a division president to oversee Mission. n Ex-Mayo Clinic CEO Dr. John Noseworthy joins UnitedHealth Group's board By Alyssa Rege J ohn Noseworthy, MD, the former president and CEO of the Mayo Clinic, joined the board of directors of UnitedHealth Group, the insurer announced Feb. 13. Stephen J. Hemsley, executive chairman of UnitedHealth Group's board, said Dr. Noseworthy's leadership "has been de- cisive in Mayo's achievement of consistently high performance in healthcare quality, safety, research and finance, while champi- oning wide-ranging improvements in the healthcare experience for both patients and physicians. … We welcome his expertise as UnitedHealth Group works to improve the future of healthcare." Dr. Noseworthy began working at the Rochester, Minn.-based health system in 1990 and served as the chief executive of the system from 2009 until his retirement last year. Under his leader- ship, the system earned $12 billion in annual revenues and em- ployed 68,000 employees. n

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