Issue link: https://beckershealthcare.uberflip.com/i/606753
13 significant lawsuits involving the strategy. Hooper, Lundy and Bookman filed a motion for preliminary approval to settle a class action complaint filed more than six years ago on behalf of out-of-network Cali- fornia ambulatory surgery centers against United Healthcare Services and OptumInsight. e com- plaint alleges United and OptumInsight improperly calculated the reasonable and customary amounts for out-of-network ASCs, leading to millions of dollars in underpayments. United agreed to a $9.5 million settlement fund. ere are an estimated 250 ASCs that could qualify to participate in the settle- ment, if the court preliminarily approves the settle- ment. Steps to participate in the settlement will be sent to all potential class members. Cigna Health and Life Insurance filed a billing fraud suit in federal court attempting to recoup millions paid to 11 Indiana-based surgical cen- ters allegedly participating in a "fee forgiveness" model to attract Cigna's out-of-network patients. Cigna claims the surgery centers attracted out- of-network members by reducing the members' copays and other fees but charging Cigna inflated prices to recoup losses. Cigna allegedly paid the 11 surgery centers more than $6.5 million in claims before realizing the centers were allegedly using the "fee-forgiving" model for out-of-net- work patients. e insurance company stopped paying those ASCs and now requests the money returned and an injunction against attempts at similar "fee-forgiving" models in the future. 8. Medicare payment data. is summer, CMS released data on Medicare payments to health- care organizations and providers. Approximately, 3,900 healthcare providers received at least $1 mil- lion each in 2013. e CMS data covered $90 billion in payments to 950,000 healthcare providers and or- ganizations. Physicians received average reimburse- ment of $74,000. Just five physicians received more than $10 million in Medicare payments. Earlier in the year, the Office of the Inspector General released the Incorrect place-of-service claims resulted in potential Medicare overpayments costing millions report. e report covers claims covering services provided from January 2010 to September 2012. During those years, Medicare contractors made $33.4 million in overpayments, due to physicians not correctly coding the place of service on physician claims. 9. HOPD vs. ASC reimbursement. ASC reimbursement as a percentage of HOPD re- imbursement has been trending downward for years. In March, the OIG released a report on 25 unimplemented recommendations that could have saved HHS programs billions of dollars. e report, the Compendium of Unimplemented Rec- ommendations, includes a section on an OIG rec- ommendation issued in April 2014 that focused on reducing Hospital Outpatient Prospective Pay- ment System rates for ambulatory surgery center- approved procedures. e OIG recommended that OPPS rates for ASC-approved procedures be determined in a non-budget neutral manner. e OIG recommended CMS seek legislation to achieve this goal. If such legislation were passed, Medicare could have generated $15 billion in sav- ings from CY 2012 to 2017. In other news, the Medicare Payment Advisory Commission recommended ASCs receive no up- dates to their facility fees in 2016. In addition to no facility fee increase, MedPAC staff recommended facilities be subject to "some form of Medicare cost reporting." MedPAC recommended a 3.25 percent payment increase for HOPDs, according to the Ambulatory Surgery Center Association. 10. Surgeon and hospital dispute over surgery center cases. e relationship be- tween hospitals and ASCs can be hostile. In June, news broke a surgeon is suing McKenzie- Willamette Medical Center in Springfield, Ore. Kristian Ferry, MD, was employed by McKenzie- Willamette Medical Center, which he alleges fired him aer he took cases to an ambulatory surgery center not owned by the hospital. Dr. Ferry is alleg- ing breach of contract, interference with his medi- cal practice, wrongful termination and defamation against McKenzie-Willamette and McKenzie Phy- sician Services. Dr. Ferry is suing the center for $6 million in economic damages and an addition $3.8 million in non-economic damages citing emotion- al distress and damage to his reputation. n SELL YOUR ASC REAL ESTATE ASCs Inc. helps you maximize the value of your aSC real eState "the industry leader in aSC sales." "ASCs Inc. helps physician-owners of ASCs realize the maximum value from their ASC business and ASC/MOB real estate. Since 1984 we have helped physicians with over 500 beneficial ASC partnership and real estate transactions. Please call us so we can discuss how we can help you achieve your goals." — Jon Vick, President • Highest prices in decades • Increase liquidity • Excellent market for selling • More buyers than sellers • A seller's market • Long term, triple-net leases Call today to get a free valuation of your ASC/MOB real estate! Contact Jon Vick at JonVick@ASCs-Inc.com 760-751-0250 or visit us online at www.ASCs-Inc.com • No personal guarantees • High valuations • Free-up your capital • No increase in rent • Low selling costs • Tax deferred exchanges