Becker's ASC Review

15 JOINT VENTURES Physician-Owned Hospital in Dallas Pays $7.5M to Settle Kickback Allegations: 5 Things to Know By Laura Dyrda P ine Creek Medical Center, a Dallas- based physician-owned hospital, paid $7.5 million to settle allegations the hospital violated the False Claims Act, ac- cording to the Department of Justice. Here are five things to know: 1. e U.S. government alleged Pine Creek illegally paid kickbacks for marketing and/ or advertising services on behalf of physi- cians who referred patients to the hospital, including Medicare and Tricare beneficia- ries. "Healthcare providers that attempt to profit from illegal kickbacks will be held account- able," said Principal Deputy Assistant Attorney General Chad Readler, who heads up the Justice Department's Civil Divi- sion. "Improper financial incentives can distort medical decision making and drive up healthcare costs for federal healthcare programs and their beneficiaries." 2. e hospital allegedly paid for radio and television advertising, pay-per-click campaigns, billboards, website upgrades, brochures and business cards, as well as other marketing forms, in exchange for patient referrals, according to the DOJ. 3. Pine Creek has agreed to pay $7.5 million to resolve the kickback claims as well as enter into a corporate integrity agreement with the Office of Inspector General. Under the integrity agreement, the hospital must undertake substantial internal compliance reforms for the next five years. 4. e allegations were originally brought in a whistle-blower lawsuit under the qui tam provision of the False Claims Act, allowing private parties to bring suits on behalf of the government. e whistle-blower is able to share in the recovery, and in this case the former Pine Creek marketing department employee who filed the suit will receive $1.125 million. 5. e U.S. government will continue to pursue kickback cases aggressively, accord- ing to the DOJ's release. "Hospitals that try to boost their profits by paying kickbacks to physicians will instead pay for their improper conduct," said Special Agent in Charge of the OIG's Dallas Region C.J. Porter. "We will continue to investigate such illegal business arrangements that under- mine impartial medical judgment." n 30 Statistics on ASC Payer Mix as a % of Collections By Laura Dyrda H ere are 30 statistics on ASC payer mix as a percent of overall ASC collections, according to VMG Health's Multi- Specialty ASC Intellimarker 2017. Medicare 1. Mean: 19 percent 2. 25 percent: 9 percent 3. Median: 16 percent 4. 75 percent: 25 percent 5. 90 percent: 37 percent Medicaid 6. Mean: 6 percent 7. 25 percent: 2 percent 8. Median: 3 percent 9. 75 percent: 8 percent 10. 90 percent: 12 percent Commercial 11. Mean: 64 percent 12. 25 percent: 55 percent 13. Median: 66 percent 14. 75 percent: 77 percent 15. 90 percent: 85 percent Worker's Compensation 16. Mean: 10 percent 17. 25 percent: 2 percent 18. Median: 5 percent 19. 75 percent: 11 percent 20. 90 percent: 24 percent Self Pay 21. Mean: 7 percent 22. 25 percent: 2 percent 23. Median: 4 percent 24. 75 percent: 10 percent 25. 90 percent: 18 percent Other Pay 26. Mean: 8 percent 27. 25 percent: 2 percent 28. Median: 4 percent 29. 75 percent: 9 percent 30. 90 percent: 15 percent

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