Here are 30 updates:
California jury awards Aetna $37.4M in ASC billing fraud scheme
A California jury found Bay Area Surgical Management and its three co-founders overbilled Aetna for out-of-network procedures by giving referring physicians a substantial kickback. The jury awarded Aetna $37.4 million in damages after four years of litigation and a month-long trial. Aetna claimed Bay Area Surgical Management cost the payer $23 million for around 1,900 procedures in the past two years — $20 million more than it should have been charged.
ASCs' quality measures soon to be under ACA magnifying glass
CMS is planning to resale eight more quality scores for ASCs, with proponents arguing ASCs should be held to the same standards for reporting patient outcomes as hospitals. The Office of the Inspector General plans to release a report on Medicare's quality oversight of ASCs.
Florida Society of Anesthesiologists files qui tam complaint against ASCs, physicians & anesthesia companies
The society filed a qui tam complaint against more than 50 physicians, anesthesiology companies and ambulatory surgical centers. In their complaint, Florida Society of Anesthesiologists alleges the defendants defrauded Medicare and Medicaid, violating the False Claims Act and the Florida False Claims Act.
5 highest-earning states for physicians
The North Central region of the United States offers, on average, the highest pay for physicians per year, according to the "Medscape Physician Compensation Report 2016."
The five top-earning states include:
• North Dakota — $348,000
• New Hampshire — $322,000
• Nebraska — $317,000
• Alaska — $314,000
• Montana — $304,000
Pfizer considers nixing $160B Allergan merger amidst new tax regulations
New York City-based Pfizer, a pharmaceutical company, is questioning whether it should move forward with its Dublin, Ireland-based Allergan merger after the Obama administration implemented new rules on tax inversion. The merger between the two drug companies is valued at $160 billion and is the largest of its kind to date.
Cerner faces overtime lawsuit
With nearly 17,000 employees, Kansas City, Mo.-based Cerner is facing a class action lawsuit due to lack of overtime pay. In the suit, two former Cerner employees claim the company miscalculated overtime pay for potentially thousands of workers. Cerner faced a similar overtime lawsuit in 2007, but the case did not move forward as a class action lawsuit.
UnitedHealth to exit Georgia, Arkansas exchanges
UnitedHealth plans to exit the Affordable Care Act exchanges in Georgia and Arkansas. The payer only entered the Arkansas marketplace last November, and did not comment why it was leaving in 2017.
CDC confirms Zika causes microcephaly
A CDC report confirmed Zika virus causes microcephaly and other serious birth defects. In the report, CDC officials detailed a wealth of evidence proving Zika causes the birth defect.
US Coast Guard terminates Epic contract
The U.S. Coast Guard terminated its $14 million EHR implementation contract with Verona, Wis.-based Epic Systems and has since reverted to using paper records. A Coast Guard spokesman offered few details to Politico regarding the state of the implementation, saying "various irregularities were uncovered, which are currently being reviewed."
Anthem Blue Cross and Blue Shield, Aurora Health Care partner for joint venture health plan
Anthem Blue Cross and Blue Shield in Wisconsin and Aurora Health Care partnered to form a joint venture health insurance company, Wisconsin Collaborative Insurance Company. Each company will open a 50 percent stake in the health insurance company.
SCA partners with Gladiolus Surgery Center
Surgical Care Affiliates partnered with Gladiolus Surgery Center in Fort Myers, Fla. Through the partnership, SCA will now operate four ASCs and more than 30 physicians in southwest Florida.
MFC CEO Britt Reynolds to start in May
Britt Reynolds will begin his role as Medical Facilities Corporation's CEO on May 1. MFC initially had a June 1st start date for Mr. Reynolds. Since January 2012, Mr. Reynolds has been president of Tenet Healthcare's hospital operations.
Tenet names Howard Hacker SVP, COO
Tenet Healthcare appointed Howard Hacker as senior vice president and COO. As COO, Mr. Hacker will lead the company's ethics and compliance programs, which Tenet's Quality, Compliance and Ethics Program Charter established.
Tenet CEO and CFO compensation slashed in 2015
In 2015, Tenet Healthcare President and CEO Trevor Fetter and the Dallas-based system's CFO Daniel Cancelmi experienced compensation cuts of 14.5 percent and 47.2 percent. Last year, Mr. Fetter had compensation of $15.4 million and Mr. Cancelmi received compensation of $4.6 million.
AmSurg's Sheridan acquires North Florida Anesthesia Consultants
Sheridan, the physician services division of AmSurg, acquired Jacksonville-based North Florida Anesthesia Consultants. North Florida Anesthesia Consultants services 18 Florida facilities including Hospital Corporation of America's Jacksonville surgery centers.
HCA's contract dispute with BCBS of Texas threatens surgery centers
Blue Cross Blue Shield of Texas is considering dropping Hospital Compaction of America's facilities in the state, which includes 30 surgical or outpatient centers and 44 hospitals. BCBS of Texas' contract with HCA expires on April 30, and the two are currently engaging in negotiations on rates.
Glenview Capital Management purchases $1B stake in HCA
During the fourth quarter, Glenview Capital Management bought 8,787,271 more shares in Hospital Corporation of America. The firm holds a $1.1 billion stake in HCA.
CMS' pay raise for Medicare Care Advantage plans falls short
CMS announced Medicare Advantage plans will receive a 0.85 percent hike in reimbursement in 2017. In February, CMS proposed a 1.35 percent increase in reimbursement for MA plans.
Overbilling costs Medicare $40B each year
A new report claims improper payments cost Centers for Medicare & Medicaid Services nearly $40 billion annually. Louisiana has the highest overfilling rate (19.4 percent), followed by Texas (17.3 percent) and Alabama (14.3 percent).
Texas hospital OR staff recorded mocking sedated patient
A Houston patient opted to record her hernia surgery after her physician was rude to her when she scheduled the procedure. The patient hid an audio record in her hair, which recorded the surgeon saying the patient was "a handful" and that he feels sorry for her husband.
Orthopedic surgeons generate $2.7M for affiliated hospitals
A Merritt Hawkins survey reported a full-time orthopedic surgeon generated an average of $2.7 million on behalf of their affiliated hospitals last year, more than any other type of physician. Orthopedic surgeons averaged $497,000 in salary while generating 5.5 times that much in hospital revenue.
Clinic CEO, physician convicted in massive drug trafficking scheme in Kentucky
A federal jury has convicted the president and CEO of a Hazard, Ky.-based medical clinic and her physician husband of more than 150 charges, including illegal distribution of drugs and healthcare fraud. The couple allegedly made millions of dollars by unlawfully prescribing large amounts of prescription drugs to patients.
New York approves John R. Oishei Children's Hospital's $18.1M ASC
The state of New York gave John R. Oishei Children's Hospital in Buffalo approval to construct an ASC. Once the ASC is about to open, it will need final approval following a site inspection. On March 23, the state Department of Health gave the ASC contingent approval.
North Carolina public hearing set on Kernersville ASC
On May 12, the North Carolina Department of Health and Human Services will host a public hearing on Novant Health's certificate-of-need application to open an ambulatory surgery center in Kernersville. On March 15, Novant Health submitted a request to move two of its operating rooms from Winston-Salem to Kernersville.
University of Michigan officials present plans to build ASC
Ann Arbor-based University of Michigan and University of Michigan Health System officials provided the Brighton City (Mich.) Council a detailed presentation about plans to construct an ASC. U of M's 313,000-square-foot ambulatory facility will offer more than 40 medical specialties and will have ample space for expansion.
Danbury Orthopedics boosts its outpatient offerings
To meet patient demand, Danbury (Conn.) Orthopedics is expanding its outpatient services. Surgeons at the center completed their first outpatient total knee, hip and shoulder replacements.
Back Pain Centers of America appoints new director of physician partnerships
Atlanta-based Back Pain Center's of America named Quintin Thomas the new director of physician partnerships. As director, Mr. Thomas will oversee the physician network expansion to meet the demands of more than 150,000 patients each year.
Mercy Health's plans for outpatient center advance
On April 13, a Toledo City (Ohio) Council moved forward with Mercy Health's expansion plans to include an outpatient center. Mercy plans to construct a 21,000-sqaure-foot renovation of the outpatient and surgery building, as well as a 33,000-square-foot addition to the emergency room.
Healthcare CEO compensation reaches $3.95M
In 2014, the average compensation for a healthcare CEO totaled nearly $3.95 million. Following healthcare CEOs, energy CEOs made an average of $3.94 million in 2014, followed by financial services non-banking CEOs ($2.71 million) and retail CEOs ($2.57 million).
Wisconsin officials waited months to report Elizabethkingia outbreak
WBAY obtained records which found the Wisconsin Department of Health Services waited until March to tell the public about the Elizabethkingia outbreak, despite the agency starting its investigation of the virus in December. The state health department said it reacted quickly to the reports concerning a potential outbreak and started an investigation. However, the agency said it did not want to alarm the public.