Becker's Hospital Review

14 CFO / FINANCE 'I really feel angry': Insured patients hit with large bills due to liens By Katie Adams M any hospitals — especially those belong- ing to large, wealthy health systems — in- crease revenue by using liens to bypass patients' insurance and collect full charges from accident victims' settlements, according to a Feb. 1 report from e New York Times. In a hospital context, a lien refers to a claim placed on a settlement payment to ensure a patient pays their entire debt without help from their insurance plan. is allows hospitals to collect money that was allocated to the patient to compensate for the acci- dent and to bypass the significant discounts they are contractually obligated to offer health plans. is revenue-building practice oen comes at the expense of low-income patients; it is most lucrative when wielded against Medicaid patients, because the plan pays lower reimbursement rates than pri- vate plans. In one instance, Medicaid patient and car accident victim Monica Smith told the NYT that Fort Wayne, Ind.-based Parkview Regional Med- ical Center ignored her requests to bill Medicaid, which would have paid bills totalling $2,500, and instead placed a lien on her settlement and pursued a $12,856 charge. Parkview's chief legal officer, David Storey, told the NYT the system no longer places liens against Med- icaid patients and that it "has always taken a conser- vative and fair approach to collections." Some hospitals hire outside debt collection agencies to search police records for recent accidents to iden- tify which of their patients were in an accident so they can place liens on their settlements, the NYT reported. Liens can oen tank patients' credit scores, leaving them unable to pay for the follow-up care they need to recover, according to the report. "I really feel angry. You are going into a fight with the hospital that you don't know the rules of," car accident victim Dennis Denson told the NYT af- ter Atlanta-based WellStar Health System placed a $13,469 lien against his settlement. A WellStar spokesperson told the NYT the system only uses liens when patients with private insurance don't provide coverage. n DOJ recovers $1.8B from healthcare false claims cases: 4 things to know By Ayla Ellison T he U.S. Justice Department obtained more than $2.2 billion in fraud and false claims settlements and judgments in fiscal year 2020, and the bulk of those recoveries came from matters that involved the healthcare industry. Here are four things to know about the Justice Department's false claims recoveries: 1. The Justice Department recovered more than $1.8 billion from healthcare false claims cases in fiscal 2020. In many of the cases, the healthcare companies agreed to or were ordered to pay additional amounts to state Medicaid programs. 2. The largest recoveries from last fiscal year came from the drug industry. For example, Novartis paid more than $591 million to re- solve claims it paid kickbacks to physicians to induce them to pre- scribe its drugs. 3. The Justice Department pursued opioid-related fraud schemes in fiscal 2020. One of the largest recoveries was from Practice Fusion, a health information technology developer that accepted kickbacks from opioid manufacturer Purdue Pharma in exchange for implement- ing alerts in its EHR software that were designed to increase prescrip- tions for OxyContin. 4. The Justice Department resolved several cases in which health- care providers billed federal healthcare programs for medically un- necessary services or services that weren't provided. King of Prus- sia, Pa.-based Universal Health Services paid $117 million to resolve allegations that its psychiatric hospitals and behavioral treatment facilities submitted false claims for services that were not medically necessary. n Billionaire sells $302M of CHS stock By Ayla Ellison C hinese investor Tianqiao Chen and his group of companies have a 9.2 percent stake in Franklin, Tenn.-based Community Health Systems after selling more than 3.5 million shares of the company, according to a Jan. 20 Securities and Exchange Com- mission filing. Mr. Chen and his Shanda Group company affiliates sold 3.56 million shares of CHS on Jan. 15 for $8.51 per share, bringing in a total of $302.7 million. The move comes after he sold more than 13 million shares of CHS between Nov. 10 and Dec. 14. Those sales brought in more than $109 million. Mr. Chen, a pioneer in China's online gaming industry, began buying up shares of CHS in 2016. The last public comment the investor made about CHS was in 2018, when Shanda Group said it had a "good re- lationship" with CHS and supported the company's strategy and man- agement team. n

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