Issue link: https://beckershealthcare.uberflip.com/i/1362166
11 CFO / FINANCE Aetna barred from seeking alleged hospital overpayments linked to Mednax billing By Morgan Haefner A etna can't pursue any overpayments it claims it made to hospitals because of alleged fraudulent billing from Mednax, a Pennsylvania court said in March. Justice Wendy Beetlestone of the U.S. District Court for the Eastern District of Pennsylvania made the decision in a memorandum opinion March 12. In the memorandum opinion, Ms. Beetlestone granted Mednax's motion to strike damages Aetna claims it is owed in hospital overpayments, which the insurer alleges were induced by the Sunrise, Fla.-based medical group's billing practices. Aetna has argued Mednax fraudulently in- flated insurance claims for services it provid- ed in neonatal intensive care units. According to March 12 court documents, Aetna brought forth calculations from a damages expert, af- ter fact discovery had closed, alleging damages from two sources: fraudulent billing from Med- nax that led to $58.3 million in overpayments, and $102.7 million that Mednax fraudulently induced Aetna to pay hospitals with practicing Mednax physicians. Ms. Beetlestone granted Mednax's motion to strike the second damages theory on hospital overpayments. She stated Aetna didn't prop- erly explain why it failed to timely disclose its seeking of damages for hospital payments, adding that the insurer had maintained hospi- tal claims weren't relevant to the case during fact discovery. "e crux of the instant dispute lies in Aetna's representations during fact discovery that pay- ments made to hospitals were not relevant to the case," Ms. Beetlestone said. e memorandum opinion comes aer Aetna asked the District Court for the Eastern District of Pennsylvania March 1 to sanction Mednax for allegedly destroying evidence in the case. Mednax has disputed the accusations and plans to file a response. n CMS is recouping advance Medicare payments By Alia Paavola C MS has begun recouping accelerated Medicare payments made to providers and suppliers to help temporarily relieve financial pres- sure from the pandemic. The agency said it would start recovering the payments March 30. The re- coupment will begin on the one-year anniversary of when the provider received the first COVID-19 Medicare accelerated and advance payment. "Please be sure your billing staff are aware that the recovery has begun, or will begin soon but no sooner than one year from the date we issued the CAAP to you," the CMS notification said. CMS will recoup the payments for 11 months at a rate of 25 percent. After the 11-month period, CMS will recover the remaining funds at a rate of 50 percent for six months. CMS said it will issue a demand letter for full repayment of any remaining balance after the two recoupment periods. n Baylor Scott & White job cuts, outsourcing expected to save $600M over next 5 years By Alia Paavola B aylor Scott & White Health's plan to outsource, lay off or retrain 1,700 employees is expected to save the health system $600 million over a five-year span, according to The Austin American-Statesman. The Dallas-based system announced plans for the restructuring in Jan- uary. Employees affected by the change work in information technolo- gy, billing, revenue cycle management and other support services. The health system said outsourcing the finance and IT jobs and other support services will help it improve efficiencies and focus on reducing costs in non-core business areas. About two-thirds of the 1,700 employees will be joining third-party RCM, IT, billing or support staff vendors. About 600 to 650 positions will be eliminated. Baylor Scott & White said that employees whose positions are being eliminated will be invited to participate in retraining programs. "To make an even greater investment in frontline care, Baylor Scott & White is announcing a change in how it operates certain non-patient corporate services," Baylor said in Worker Adjustment and Retraining Notification Act letters obtained by the American-Statesman. "Our goal is that every impacted employee will be offered a comparable employment option, in- side or outside of BSWH, and no one will miss a paycheck because of this transition." According to the WARN notice, 216 employees will be laid off in the Texas cities of Dallas, Round Rock and Austin by May 3, and the layoffs will be permanent. n