Becker's Hospital Review

20 CFO / FINANCE HCA hit with antitrust lawsuit By Alia Paavola A group of Western North Caroli- na residents has filed a class-ac- tion antitrust lawsuit alleging that Nashville, Tenn.-based HCA Healthcare en- gaged in anticompetitive tactics that result- ed in higher prices and lower-quality care for patients. e 87-page lawsuit, filed in Buncombe County Aug. 10, alleges that aer HCA purchased Asheville, N.C.-based nonprofit Mission Health in 2019, the for-profit par- ent company used a monopoly in Ashe- ville to raise prices for both inpatient and outpatient care. In one instance cited in the lawsuit, the plain- tiffs claim that HCA currently charges more than two times the state average for a C- section without complications. "is price disparity — one matched and ex- ceeded by numerous other procedures — can only exist because of the system's unbridled monopoly power and its status as a 'must have' system in Western North Carolina," the plaintiffs claim. Further, the plaintiffs claim that HCA holds a 70 percent or more market share for inpa- tient services in seven North Carolina coun- ties, including Yancey, where it has a 90.9 percent market share, and Madison, where it has a 90 percent market share. "Because insurers and consumers in the re- gion have no choice but to use HCA, HCA has free rein to dictate the prices it charges insurers and consumers while at the same time undermining quality to cut costs," the lawsuit claims. e plaintiffs also claim that HCA has been cutting costs and staff "at an alarming rate," allegedly leaving Western North Carolinians with worse healthcare. "e plaintiffs allege that an out-of-state corporation has used its market power to cut quality and raise prices, harming doc- tors and consumers," said Mona Lisa Wal- lace, one of the attorneys representing the plaintiffs. "Mission Health was once the crown jewel of North Carolina's healthcare system. In filing this action, the plaintiffs seek to have HCA live up to its promises of providing quality affordable healthcare in Western North Carolina." e plaintiffs are asking the court to certify the class, declare that HCA has monopo- lized the local market and award damages, among other requests. Nancy Lindell, a Mission Health/HCA Healthcare North Carolina Division spokes- person, told Becker's Hospital Review that HCA will respond through the legal process once it is served with the lawsuit. "Once we have been served with the law- suit, we will respond appropriately through the legal process," Ms. Lindell said. "We are committed to caring for Western North Car- olina as demonstrated through more than $330 million in Charity Care and uninsured discounts we provided in 2020, expansion of hospital services including the opening of the North Tower, a new pediatric ER, and securing land for a new 120-bed behavioral health hospital. Further, we have invested in our colleagues with onboarding nearly 1,200 new members this year and providing more than $3 million in student loan and tuition reimbursement in 2020. Mission Health is committed to the health and well-being of every person who comes to us for care and we are proud of our dedicated hospital teams that are facing the many challenges of this pandemic and the exceptional care they have provided to our patients." e plaintiffs are represented by Wallace & Graham in Salisbury, N.C., and Fairmark Partners, based in Washington, D.C. n Cardiologist gets 6+ years in prison for 'fountain of youth' billing scam By Alia Paavola A cardiologist was sentenced to 6 1/2 years in prison Aug. 5 for his role in a fraud scheme involving more than $13 million in false insurance claims, accord- ing to the Pittsburgh Post-Gazette. In addition to the prison sentence, Samirkumar Shah, MD, was ordered to pay $1.2 million in restitution. U.S. District Judge David Cercone ordered the sentence. Dr. Shah was convicted of two counts of healthcare fraud in 2019. Prosecutors said during his trial that Dr. Shah submitted fraudulent claims to both private and govern- ment insurers for external counter pulsation, an outpatient treatment meant to increase blood flow to the heart. Dr. Shah offered these treatments to patients who didn't need them, including those with obesity, migraines and erectile dysfunction, according to prosecutors. Dr. Shah advertised the treatment as the "fountain of youth" and claimed the treatments made patients "younger and smarter," prosecutors said. Insurers cover external counter pulsation for patients who have disabling angina. Insurance plans also require a phy- sician to supervise the treatment. Prosecutors said Dr. Shah directed employees to falsify documents to indicate that all patients who received the treatment suffered from disabling angina even though they didn't and had patients undergo the treatment when he wasn't supervising it. Prosecutors said Dr. Shah submitted $13 million in false claims to insurers for these treatments, and insurers paid $3.5 million. n

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