Becker's Hospital Review

24 CFO / FINANCE Prime Healthcare, CEO settle billing fraud allegations By Ayla Ellison O ntario, Calif.-based Prime Health- care Services and its founder and CEO Prem Reddy, MD, have agreed to pay the federal government $1.25 million to settle false claims allegations, according to the U.S. Department of Justice. e settlement resolves allegations that two Prime hospitals — Roxborough Memorial Hospital in Philadelphia and Lower Bucks Hospital in Bristol, Pa. — violated the False Claims Act. e hospitals allegedly admitted patients for overnight stays who required less costly outpatient care. e hospitals also billed for more expensive patient diagnoses than the patients had, the Justice Department alleged. Prime acquired Roxborough Memorial Hos- pital on Feb. 22, 2012, and acquired Lower Bucks Hospital on Oct. 3, 2012. From the dates Prime acquired the hospitals until Sept. 30, 2013, the two hospitals allegedly admit- ted Medicare patients for medically unnec- essary short-stay admissions. e hospitals allegedly upcoded inpatient diagnoses from the dates of acquisition until Dec. 31, 2014, according to the Justice Department. "Prime Healthcare is pleased to have resolved this lawsuit," Joel Richlin, Prime Healthcare's deputy general counsel, said in an emailed statement. "is settlement allows Prime Healthcare to continue to focus on its mis- sion of providing quality, compassionate healthcare while saving hospitals, saving jobs and saving lives." e allegations against Prime were originally brought by a former employee of Roxborough Memorial Hospital under the qui tam, or whis- tle-blower, provisions of the False Claims Act. e claims resolved by the settlement are alle- gations only and there was no determination of wrongdoing. According to a Prime Healthcare spokesperson, the quality of clinical care pro- vided at the hospitals was never in question. n HCA completes $1.5B acquisition of Mission Health By Ayla Ellison N ashville, Tenn.-based HCA Healthcare now owns 185 hospitals af- ter completing its purchase of Mission Health, a six-hospital system based in Asheville, N.C. The $1.5 billion deal closed five months after HCA, one of the nation's largest for-profit hospital operators, and Mission signed a definitive agreement. "We are very pleased that this transaction has now closed so that Mission Health can continue to focus on caring for the people of western North Caro- lina," Mission Health President and CEO Ronald A. Paulus, MD, said in a press release. "This is a tremendous win for the people and communities that we serve, and one that may be judged by history as a positive inflection point for the communities we serve." HCA plans to make significant investments in Mission Health's facilities, includ- ing building a replacement hospital for Angel Medical Center in Franklin, N.C., and completing the Mission Hospital for Advanced Medicine in Asheville. "The team at Mission Health has been nationally recognized for provid- ing high-quality patient care, and we're excited that they've joined HCA Healthcare," said HCA Healthcare CEO Sam Hazen. "We're looking for- ward to investing in western North Carolina and helping ensure Mission Health's 133-year tradition of caring for communities throughout the region continues for many years." n Walmart teams up with Ochsner for joint replacement program By Ayla Ellison W almart is aiming to lower spending and improve healthcare out- comes for its employees by sending them to New Orleans-based Ochsner Health System for hip and knee replacements. Four things to know: 1. Over the past five years, Walmart has encouraged employees to undergo a variety of procedures, including spine, heart, and hip and knee surgeries, at hospitals known for providing high-quality care. As an incentive, the retail giant offered to pay for the full cost of the procedures and travel. 2. Most recently, Walmart teamed up with Ochsner. Walmart will send em- ployees from across the nation to Ochsner's flagship facility for hip and knee replacement surgery. Ochsner is the 12th healthcare organization named a Walmart Center of Excellence for joint replacement surgery. 3. "Our team is honored to partner with Walmart to provide their team mem- bers from across the country with world-class orthopedic care," George Chimento, MD, department chairman of orthopedics at Ochsner, said in a press release. "This partnership will allow thousands of individuals to receive life-changing medical services, while keeping healthcare affordable." 4. The designation builds on the existing partnership between Walmart and Ochsner. In 2018, the two organizations launched a health insurance plan for about 6,600 Walmart and Sam's Club employees. n

• Cover