Here are 30 updates:
Indiana surgery centers file lawsuits against UnitedHealthcare for overpayments
Various Indiana surgery centers are filing lawsuits against UnitedHealthcare for allegedly failing to pay for services the center's physicians rendered to patients, thereby violating state and federal law. UnitedHealthcare maintains it complied with all the appropriate state and ERISA laws and regulations, and utilized "cooperative overpayment recoveries."
California ASCs get final approval for $9.5M United Health suit
The U.S. District Court for the Central District of California granted final approval for a settlement with United Health Services, which will give $9.5 million to 270 California ambulatory surgery centers. The class action claimed United Healthcare and several of its corporate subsidiaries, including Optum, failed to properly calculate the reasonable and customary amounts for out-of-network ASCs.
Illinois physician charged with first-degree murder, denied bail reduction
An Illinois judge denied Brian Burns, MD, a bail reduction after police arrested and charged him in March with first-degree murder in connection with the slaying of his estranged wife. Prosecutors accuse Dr. Burns of shooting his estranged wife, Carla Burns, and concealing her death.
CMS updates Medicare Part B data
CMS released its updated Physician and Other Supplier Utilization and Payment public use data, which includes summarized information on Part B services and procedures provided to Medicare beneficiaries. By the end of this year, CMS intends to tie 85 percent of all traditional Medicare payments to quality or value.
242 legislators oppose Medicare Part B payment proposal
A group of 242 legislators are urging the Obama administration to get rid of the proposed payment changes to Medicare Part B. Legislators caution the program may harm patients by limiting their access to treatment.
Medicare loses $3.2B from DMEPOS improper medical billing
In 2015, Medicare had a 40 percent improper payment rate for improper medical billing for durable medical equipment, prosthetics, orthotics and supplies, resulting in $3.2 billion losses. The DMEPOS billing error rate is nearly three times higher than the national Medicare fee-for-service improper payment rate (12 percent).
Physicians accept responsibility for Joan Rivers' death
Five physicians from New York-based Yorkville Endoscopy agreed to pay a "substantial" amount and accepted responsibility for the death of comedian Joan Rivers to settle a malpractice lawsuit brought by her family. The suit alleged the physicians, in addition to being star-struck and eager to please, made a series of errors that led to Ms. Rivers' death.
ASCA's William Prentice responds to NYT's Joan Rivers piece, defends patient safety at ASCs
William Prentice, CEO of Ambulatory Surgery Center Association, wrote a short rejoinder to The New York Times in response to their coverage of the settlement between Joan Rivers' family and Yorkville Endoscopy. Mr. Prentice wrote a letter to the editor in which he noted ASCs are, in fact, subject to the same federal and state oversight as hospitals and the "the doctors and nurses who work in these centers have the same education, training and credentials as those who perform surgery in hospitals."
Mount Sinai to shutter Beth Israel hospital
New York City-based Mount Sinai Health System has unveiled a plan to shutter 856-bed Mount Sinai Beth Israel and replace it with a much smaller 70-bed facility. Mount Sinai said less than 60 percent of the hospital's beds are occupied, on average, and patient volume at the financially troubled hospital has decreased by double digits since 2012, prompting its decision to replace the facility.
Patient dies after jumping from window at Florida hospital
Police are investigating the death of a Winter Haven (Fla.) Hospital patient who died Saturday after jumping from a window on the hospital's third floor. The patient jumped from the window in his room and was pronounced dead at 1:19 p.m.
Mid-Valley Oral Maxillofacial & Implant Surgery sustains major fire damage
The Mid-Valley Oral Maxillofacial & Implant Surgery in Salem, Ore., has sustained significant damage due to a recent fire. There were no injuries due to the fire. However, it may not be possible to recover the building.
Tenet senior strategic advisor Reginald Ballantyne III to leave in June
Tenet Healthcare senior strategic advisor Reginald M. Ballantyne III is ending his career at the company on June 30. In 2013, Mr. Ballantyne played an essential, "behind the scenes" role in expanding the Arizona Health Care Cost Containment System.
Tenet reports $59M net loss in Q1
For the first quarter of 2016, Tenet Healthcare had a net loss of $59 million, or $0.60 per share, compared to a net income loss of $47 million, or $0.47 per share, in the first quarter last year.
AmSurg acquires Jandee Anesthesiology Partners & Karadan Anesthesiology and Pain Management
Sheridan, AmSurg's physician services division, acquired Jandee Anesthesiology Partners and Karadan Anesthesiology and Pain Management, thereby expanding its anesthesiology services business. Jandee Anesthesiology Partners and Karadan Anesthesiology and Pain Management have five physicians. The groups' five physicians provide anesthesia services at nine ambulatory surgery centers and other New Jersey and New York practices.
AmSurg net revenues reach $724.7M
AmSurg net revenues reached $724.7 million during the first quarter of 2016, a 27 percent increase from $570.4 million for the same quarter of 2015.
SCA partners with Dublin Surgery Center
Surgical Care Affiliates partnered with Dublin (Ohio) Surgery Center, effective May 1, 2016. As of May 3, 2016, SCA operated 198 surgical facilities.
SCA names Kenneth Goulet to board of directors
Kenneth R. Goulet is joining Surgical Care Affiliates' board of directors, starting June 1, 2016. Prior to joining SCA, Mr. Goulet held leadership roles with Anthem, including executive vice president and president of Anthem's commercial and specialty business.
Medical errors rank as 3rd leading cause of death
A BMJ study found medical errors are the third leading cause of death in the United States, following heart disease and cancer. Using data derived from U.S. hospitals in 2013, the study found medical errors cause nearly 251,454 deaths each year.
CMS publishes final fire safety updates for healthcare facilities, including ASCs
For ASCs specifically, all doors to hazardous areas must be self-closing or must close automatically. Additionally, alcohol-based hand rub dispensers may be placed in corridors to allow for easier access.
Humana considers leaving ACA marketplaces
Humana recently gave notice it may leave some Affordable Care Act exchanges in 2017. In an email, a Humana spokesperson wrote, "We do not take these changes lightly. We are striving to avoid unnecessary coverage disruption whenever possible." The payer did not delve into detailed changes for 2017.
CMS grants deeming status to Institute for Medical Quality for ASC accreditation
CMS granted the Institute for Medical Quality deeming status as a national accrediting organization for ambulatory surgery centers participating in Medicare or Medicaid.
Bundle lowers SSI infection risk
Mayo Clinic researchers found a surgical site infection reduction bundle greatly lowered the risk of a SSI. The relative risk reduction for organ and space SSI was 73.3 percent.
Python falls from ceiling at Tacoma hospital
A visitor snuck the snake into the hospital while the snake's owner was in the hospital. When the visitor went home from the hospital, he realized the python had escaped the carrier and immediately notified Tacoma General. The snake was found and reunited with his owner a month later.
CMS posts individual physician payments for 2014
More than 986,000 clinicians were included in the data, receiving around $91 billion in Medicare payments in 2014. In 2013, CMS included 950,000 clinicians in the data-dump, receiving around $90 billion.
Major insurance mergers spend $400M+ on legal & banking services
Anthem has spent nearly $139 million after taxes on financial consulting, legal fees and bridge-loan financing costs. Similarly, Aetna spent at least $119 million after taxes to prepare for its Humana purchase. Cigna paid lawyers and bankers $93 million and Humana paid lawyers and bankers $52 million, both after taxes. Since the deals were announced last summer, the two insurers have paid nearly $403 million in total in acquisition-related costs.
Federal judge rules parts of ACA are 'illegal'
U.S. District Judge Rosemary Collyer ruled President Obama went above his authority by unilaterally funding an ACA provision that gave billions of dollars of subsidies to health insurance companies. Judge Collyer put her rule on hold pending the Obama administration's appeal.
Anesthesiologist to serve prison sentence for unlawfully distributing controlled substances, fraud
An anesthesiologist was sentenced to 100 months in prison in federal court in Louisville, Ky., for his role in the unlawful distribution of controlled substances, including the prescription opioid hydrocodone, without a legitimate medical purpose, as well as related crimes.
CMS says MACRA will not disproportionably penalize small practices
In a hearing last week, Acting CMS Administrator Andy Slavitt said small practices can succeed just as much as larger practices under CMS' Medicare Access and CHIP Reauthorization Act. CMS initially estimated most clinicians in groups of 24 or fewer will endure a penalty in 2019. Mr. Slavitt is claiming that figure is not indicative of the reality and CMS will help small practices so they can succeed in obtaining bonuses.
Pfizer acquires Anacor for $5.2B
Pfizer and Anacor Pharmaceuticals entered into a definitive merger agreement in which Pfizer will acquire Anacor for nearly $5.2 billion. Pfizer projects to complete the acquisition in the third quarter of 2016.
Whistle-blower claims 33 hospitals submitted more than $1B in fictitious costs
A whistle-blower recently defended the viability of a federal complaint he filed, saying 33 hospitals in North Carolina, South Carolina and Georgia benefited from fictitious cost report claims submitted to Medicare and Medicaid.
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