Becker's ASC Review

12 ASC MANAGEMENT ASCs and hospitals pay millions as scrutiny intensifies for illegal referrals By Laura Dyrda T he U.S. Justice Department is putting hospitals, ASCs and physician groups under the microscope, in search of improper relationships that violate anti-kickback laws, which could have big consequences for the industry. Seven lawsuits and settlements in the last year, with combined payments topping $55 million: 1. Akron (Ohio) General Health System agreed to pay $21 million to settle allegations it made improper payments to physicians for referrals from 2010 to 2016, according to a July 2 statement from the Justice Department. Aer the system was acquired by Cleveland Clinic in 2015, it voluntarily disclosed an alleged improper financial relationship with physician groups. 2. Surgical Care Affiliates, based in Deerfield, Ill., and Orlando Center for Outpatient Surgery, agreed to pay $3.4 million in June to settle allegations of paying kickbacks for referrals relat- ed to kidney stone procedures. A whistleblower lawsuit alleged the center paid urologist Patrick Hunter, MD, pre-procedure payments for his lithotripsy procedures. Dr. Hunter's estate separately paid $1.75 million to resolve the allegations. 3. In April, three Ascension-affiliated hospitals in Texas agreed to pay $20.9 million for paying physicians above market value for services, including on-call coverage and administrative oversight of specialty programs. 4. Ashok Kumar, MD, paid $215,228 to settle allegations he ac- cepted kickbacks in exchange for referring patients to Memo- rial Hospital of Gardena (Calif.) in March. Other defendants paid an $8.1 million settlement in 2018 to resolve claims the hospital paid above market value to induce referrals. 5. Collier Anesthesia Pain in Fort Myers, Fla., and Tampa (Fla.) Pain Relief Clinic agreed to pay $1.6 million to resolve accusations they violated anti-kickback statutes in February. e two groups were accused of sending patients for surgery at ASCs where copayments were waived and submitting improper claims for ancillary tests and services. 6. Bismarck, N.D.-based Mid Dakota Clinic paid $5.5 million to settle allegations of an improper financial arrangement with its wholly owned ASC in October 2020. A whistleblower lawsuit alleged the clinic's physicians could make or influence referrals to the ASC and gather revenue. 7. Advanced Pain Management in Greenfield, Wis., paid $1 million to settle allegations in October 2020, that the company provided stock incentives to nonemployed physicians to perform procedures at its ASCs and in some cases paid non- employee physicians to be medical directors. n 10 of the largest ASC chains in the United States in 2021 By Laura Dyrda Many of the largest ASC chains in the U.S. grew last year dur- ing the pandemic. Here is where 10 companies stand with the number of ASCs in their network as of June 2021. 1. United Surgical Partners International (Dallas): 312 2. AmSurg (Nashville, Tenn.): 250+ 3. Surgical Care Affiliates (Deerfield, Ill.): 250+ 4. HCA Healthcare (Nashville, Tenn.): 142 5. Surgery Partners (Brentwood, Tenn.): 109 6. SurgCenter Development (Towson, Md.): 92 7. PE GI Solutions (Jamison, Pa.): 60+ 8. ValueHealth (Leawood, Kan.): 50+ 9. Covenant Physician Partners (Nashville, Tenn.): 48 10. Regent Surgical Health (Chicago and Nashville, Tenn.): 22 Last year, USPI and SCA added more than 1,000 physicians to their ASC networks and have plans to add thousands more this year. The companies also are partnering with health systems to expand their networks. n OptumHealth now serves 99 million patients, Q2 revenue rises 46% By Laura Dyrda O ptum delivered a strong financial performance in the second quarter, driven by growth across all divisions, it reported July 15. Four notes: 1. OptumHealth, which includes ASC chain Surgical Care Affiliates, reported $13.3 billion in quarterly revenue, up 46 percent from $9.1 billion during the second quarter of 2020. For the six month's end June 30, OptumHealth reported $25.7 billion in revenue. 2. OptumHealth said revenue per customer jumped 43 per- cent year over year. The division served 99 million by the end of the quarter, up 2 million from the same period last year. 3. The company executed its plan to boost the number of members in value-based care arrangements and added affili- ated physicians and outpatient services as well. 4. Overall, Optum's quarterly revenues were $38.3 billion, up 17.2 percent, and earnings from operations hit $2.9 billion. Its operating margin was 7.5 percent on June 30. n

• Cover