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58 HEALTHCARE NEWS Trump Executive Order Hints at Limiting Healthcare Consolidation, Promotes Price Transparency — What Does This Mean for ASCs? By Laura Dyrda O n Oct. 12, President Donald Trump released an executive order with further instructions to dismantle the ACA. e bulk of his executive order focused on health insurance, but he also addressed his administration's plans to limit consolidation and promote competition in healthcare markets. Here are five quick notes: 1. Section 1 (C) states: "My administration will also continue to focus on promoting competition in healthcare markets and limit- ing excessive consolidation throughout the healthcare system." Consolidation had been a chief concern for ASCs as increased regula- tion, low reimbursements and technology costs, among other factors, have made it more difficult for independent centers to survive. 2. e Trump administration, per the executive order, announced plans to "lower barriers to entry, limit excessive consolida- tion and prevent abuses of market power" as a way to improve competition in the future. However, the executive order did not give specifics as to how this would occur. 3. Healthcare information transparency was also addressed in the executive order, promoting transparent data on healthcare prices and outcomes without placing undue reporting burden on payers, providers and plans. Select ASCs across the country have begun quality and price transparency initia- tives, posting outcomes benchmarks and global pricing online. It does take consider- able upfront work to gather data and develop an appropriate price, especially for global or bundled payments. 4. In relation to health insurance, the execu- tive order noted premium increases recorded since 2013 and highlighted policies that led to consolidation and limited competition among health insurance companies. Presi- dent Trump's administration will champion association health plans; short-term, limited duration insurance; and health reimburse- ment arrangements. ese moves aim to achieve several goals, including making it less costly for small businesses, such as many ASCs, to provide health insurance. 5. Shortly aer the executive order was signed, HHS announced it would discon- tinue cost sharing reduction payments to insurance companies initiated by the ACA, believing they were unlawful because they weren't appropriated by Congress. "In 2016, a federal court ruled that the Administration had circumvented the ap- propriations process and was unlawfully using unappropriated money to fund reim- bursements due to insurers," HHS Acting Secretary Eric Hargan and CMS Administra- tor Seema Verma said in a statement. "Aer a thorough legal review by HHS, Treasury, OMB and an opinion from the Attorney General, we believe that the last Adminis- tration overstepped the legal boundaries drawn by our Constitution. Congress has not appropriated money for CRS, and we will discontinue these payments immediately." is move will affect health insurance com- panies, especially those serving low-income individuals in the ACA marketplace. e AMA released a statement opposed to end- ing the subsidies, noting both Republicans and Democrats in Congress have expressed concern about eliminating CRS funding. "is most recent action by the Administra- tion creates still more uncertainty in the ACA marketplace just as the abbreviated open enrollment period is about to begin, further undermining the law and threatening access to meaningful health insurance cover- age for millions of Americans," said AMA President David Barbe, MD, in a statement. "Our patients will ultimately pay the price. We urge Congress to accelerate its efforts to reinstate these payments before further dam- age is done." n DOJ: Personal Trainer Posed as Physician in $25M Scheme By Ayla Ellison A 54-year-old personal trainer was arrested in Fort Worth, Texas, Oct. 12, and charged with engaging in a scheme to defraud insurance companies by submitting more than $25 million in false claims for medi- cal services, according to the Department of Justice. The government claims David Williams, the personal trainer, identified himself as "Dr. Dave" on his website and said he offered in-home fitness training and therapy. Mr. Williams' website stated he accepted most health insur- ance plans, according to the DOJ. To bill health insurance companies for his fitness and exer- cise training services, Mr. Williams allegedly registered as a healthcare provider with CMS and then billed insurance companies as if he were a physician. He allegedly used different names to enroll as a healthcare provider at least 19 times. The government alleges Mr. Williams used inaccurate codes to bill for the services he and his staff provided, and he sometimes billed for services that had not been provided. From November 2012 through August 2017, Mr. Williams submitted $25 million in false claims to UnitedHealthcare, Aetna and Cigna, and he was paid more than $3.9 million in relation to those claims. If proven guilty, Mr. Williams faces up to 10 years in fed- eral prison and a $250,000 fine. n

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