Becker's Hospital Review

18 CFO / FINANCE Physicians accepted $40M in kickbacks from Texas hospital, feds say By Ayla Ellison T he federal trial for 10 defendants, includ- ing four surgeons and a pain physician, accused of participating in a $200 mil- lion healthcare fraud scheme kicked off in Feb- ruary, according to e Dallas Morning News. Five things to know: 1. e trial, which is expected to last up to two months, centers on bribes and kickbacks now-defunct Forest Park Medical Center in Dallas allegedly paid to physicians and sur- geons to steer surgeries to the hospital. 2. e alleged scheme, which began in 2009 and ran through 2013, involved paying sur- geons for referring patients to the medical center, which was out of network with payers. Instead of billing patients for out-of-network copayments, hospital executives and physi- cians allegedly assured patients they would pay in-network prices. ose involved allegedly concealed the patient discounts and wrote off the difference as uncollected bad debt. 3. ere were 21 defendants charged in 2016, 11 of whom have pleaded guilty and are expected to testify on behalf of the government at trial, according to e Dallas Morning News. 4. e $200 million healthcare fraud scheme allegedly involved FPMC officials making $40 million in illegal payouts to surgeons and others in exchange for referrals. Although the $40 million in payments looked legitimate, they were really "bribes and kickbacks," a gov- ernment lawyer told the jury during opening arguments on Feb. 21, according to Law360. 5. Several of the defendants have denied wrongdoing. ey claim healthcare attorneys told them the marketing agreements they en- tered into, which are at the center of the kick- back allegations, were not illegal, according to e Dallas Morning News. n Anthem accused of sending massive checks to patients to force providers in network By Ayla Ellison S an Clemente, Calif.-based Sovereign Health is suing Anthem and its Blue Cross entities for sending more than $1.3 million in payments to patients that is allegedly owed to facilities that treat- ed them, according to CNN. Three things to know: 1. The lawsuit alleges Anthem is sending payments directly to patients after they seek out-of-network care to pressure providers into joining its network and accepting lower reimbursement, according to the report. 2. The patients are supposed to send the money to providers, but some patients don't. Arthur Caplan, PhD, director of medical ethics for New York Universi- ty's School of Medicine, told CNN it's "insane" to send reimbursement directly to patients. "I'm enormously surprised that anyone would think this is a doable ap- proach," he said. 3. In court filings, Anthem does not dispute that checks are given to patients in some cases for out-of- network care. The insurer argues Sovereign Health's lawsuit should be dismissed for lack of legal stand- ing. The insurer also argues previous court decisions determined anti-assignment clauses that allow for payments to patients are legal, according to CNN. n Attorney general investigates 2 Kansas hospitals that abruptly closed By Ayla Ellison T wo Kansas hospitals owned by Kansas City, Mo.-based EmpowerHMS closed with little notice to employees or local officials, according to KCUR. Horton (Kan.) Community Hospital, a 25-bed critical access hospital, closed March 12. The hospital, which faced financial challenges for months, was nearly 30 days behind on payroll when it shut down. Horton Community Hospital closed just weeks after Oswego (Kan.) Community Hospital abruptly shut down. In a statement announcing the closure, the board said Oswego Community Hospital wasn't bringing in enough revenue to cover payroll and other expenses. A spokesperson for Kansas Attorney General Derek Schmidt told KCUR that Horton Community Hospital is being investigated by the attorney general›s office. The Kansas attorney general has also launched an investigation into Oswego Community Hospital, according to The Morning Sun. Until recently, Horton Community Hospital and Oswego Com- munity Hospital had been owned and operated by Empow- erHMS. In January, EmpowerHMS transferred management of 13 of its hospitals to Miami-based iHealthcare, according to KCUR. However, EmpowerHMS is still responsible for fulfill- ing the hospitals' financial obligations, including payroll and other operating expenses. n

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