HCA - Parkridge Fined $16.5 Million
HCA Inc., one of the nation’s largest private hospital chains, has agreed to pay $16.5 million to settle alleged violations of the Ethics in Patient Referrals Act (also known as the Stark law), the False Claims Act, and other federal and state laws and regulations in connection with the operation of its subsidiary, Parkridge Medical Center, Inc., in Chattanooga. In addition, Parkridge Medical Center has entered into a comprehensive five-year Corporate Integrity Agreement with the Office of Inspector General of the U.S. Department of Health and Human Services (HHS-OIG) to ensure its continued compliance with federal health care benefit program requirements.
During 2007, HCA, through its subsidiaries Parkridge and HCA Physician Services (HCAPS), entered into a series of financial transactions with a physician group, Diagnostic Associates of Chattanooga, through which it provided financial benefits intended to induce the physician members of Diagnostic to refer patients to HCA facilities. The financial benefits included lease of office space from Diagnostic at a rental rate well in excess of fair market value to meet the mortgage obligations of the Diagnostic members and release of Diagnostic members from a separate lease obligation. These financial arrangements violated the Ethics in Patient Referrals Act and the Anti-Kickback Statute – laws designed to protect patients as well as the integrity of government-funded health care benefit programs such as Medicare, Medicaid, TRICARE, and TennCare.
As U.S. Attorney Bill Killian explained, “Physicians should make decisions regarding referrals to health care facilities based on what is in the best interest of patients without being induced by payments from hospitals competing for their business.”
Federal law prohibits hospitals from submitting claims to government-funded health care benefit programs for inpatient and outpatient hospital services referred, ordered, or arranged for by physicians who have prohibited financial arrangements with those hospitals.
"We will not allow hospitals to provide financial incentives to induce physicians to steer patients their way," said Derrick L. Jackson, Special Agent in Charge, HHS-OIG in Atlanta. "These arrangements can corrupt medical decision-making and may result in unnecessary diagnostic testing and hospital admissions."
During the period from 2007 through 2011, HCA through Parkridge, submitted or caused to be submitted claims to Medicare, TRICARE, and TennCare/Medicaid for inpatient and outpatient hospital services referred, ordered or arranged for by the Diagnostic physician members who benefitted from the prohibited financial arrangements between HCA Diagnostic. Medicare and the other health care benefit programs paid the claims for those hospital services, and this settlement addresses the financial harm to the Medicare and Medicaid trust funds, TriCare and TennCare for the moneys paid out of those funds which HCA improperly claimed and received during that time period. Under the False Claims Act, a recipient of such funds may be liable for as much as three times the amount paid by the government program plus civil penalties.
The determination of the losses suffered by the government in a False Claims Act case based on violations of the Stark law depends largely upon the number of physicians who benefitted from the financial arrangements with the hospital, the number of patients referred by those physicians to the hospital, and the amount paid by the government to the hospital for claims submitted for all those patients. The False Claims Act further provides for trebling of any losses and penalties of between $5,500-$11,000 per claim.
“Today's settlement is the third since 2005 involving violations by hospitals in Chattanooga of the Ethics in Patient Referrals and False Claims Acts and reflects the Justice Department's continued determination to enforce these laws to protect both patients and the Medicare and Medicaid trust funds,” said U.S. Attorney Killian. Mr. Killian further noted that this settlement resulted from a comprehensive investigation which began as a result of a qui tam or whistleblower complaint filed in 2008. After an administrative subpoena was served on HCA subsidiaries in July 2009, HCA produced documents to the United States and made its personnel available for interviews.
"The Defense Criminal Investigative Service is committed to ensuring that TRICARE, the U.S. military health care program, continues to provide safe and superior medical care to America's Warfighters and their families." said John F. Khin, Special Agent in Charge, Defense Criminal Investigative Service- Southeast Field Office. "The successful resolution of this case demonstrates the effectiveness of joint investigations to combat health care fraud and preserve the integrity of this vital program."
Tennessee Attorney General Bob Cooper noted: "We are proud to have worked closely with our federal partners to bring this case to resolution. Combating fraud is essential to the strength and integrity of the TennCare program and is a high priority of this office."
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Last Update on January 26, 2015 18:16 GMT
ATHENS, Greece (AP) -- Radical left leader Alexis Tsipras has been sworn in as Greece's new prime minister, becoming the youngest man to hold the post in 150 years.
Tsipras' anti-bailout Syriza party gained the backing needed to form a government by creating an alliance with a small right-wing nationalist party.
Syriza won 36.3 percent of the vote in Sunday's early general elections but fell two seats short of the necessary majority in the 300-seat parliament to form a government on its own. The Independent Greeks party took 4.7 percent of the votes. The two ideologically opposed parties share only their opposition to the bailout.
The surprise alliance boosted stock markets across Europe that had fallen on news of the uncertain election results and fear of a second election. Stocks had fallen as much as 4 percent in Athens on Monday morning, before recovering.
MEDICARE PAYMENT OVERHAUL
WASHINGTON (AP) -- The Obama administration is unveiling what it calls a historic shift in the way Medicare pays hospitals and doctors. The goal is to reward quality care and not just the sheer volume of services like imaging scans.
Health and Human Services Secretary Sylvia M. Burwell made the announcement today, before a broad cross-section of health care industry representatives including insurers, hospitals and doctors, as well as employers, who finance coverage for most workers and their families.
Building on experiments under the president's health care law, Burwell set a goal of tying 50 percent of payments under traditional Medicare to new models of care by the end of 2018.
That can include so-called accountable care organizations, which coordinate care to help keep patients out of the hospital.
IBM JOB CUTS
SAN FRANCISCO (AP) -- IBM is pooh-poohing a published report that the giant technology company is planning a big reorganization and massive job cuts affecting more than 100,000 people.
The company disclosed plans for some layoffs last week, but it says in a statement that they affect "several thousand people," or "a small fraction of what's been reported."
That's in contrast with a report that appeared last week on the website of Forbes magazine, which predicted as many as one in four IBM employees might lose their jobs in a massive shake-up called "Project Chrome." IBM issued another disappointing earnings report last week that showed fourth-quarter revenue and net income had fallen.
The company says some workers will leave as IBM "rebalances" to make room for hiring about 15,000 workers with new skills.
EL SEGUNDO, Calif. (AP) -- Toy maker Mattel says Bryan Stockton has resigned after about three years of leading the struggling maker of Barbie dolls and Hot Wheels cars.
The El Segundo, California, company also is reporting preliminary four-quarter earnings and revenue that missed Wall Street expectations, and its stock is sliding.
The company says longtime board member Christopher A. Sinclair will replace Stockton as chairman and interim CEO. Stockton because CEO in January 2012 and then was named chairman a year later.
Mattel Inc. says it earned 44 cents per share in the fourth quarter, or 52 cents per share, not counting hits from integration costs and taxes. Revenue fell 6 percent to $1.99 billion.
Analysts were expecting 91 cents per share on $2.14 billion in revenue.
RICHMOND, Va. (AP) -- Rock-Tenn and MeadWestvaco are joining to form a $16 billion packaging company.
As part of the deal, MeadWestvaco Corp. stockholders will receive 0.78 shares of the combined company for each share they own. Rock-Tenn shareholders will be allowed to choose either 1 share of the combined company or a specific cash amount for each RockTenn share held.
Rock-Tenn CEO Steven Voorhees will be the CEO of the new company.
The boards of both companies approved the deal, which still needs approval from shareholders.
Within three years, the deal is expected to result in annual cost savings of $300 million, though officials did not say if the savings would include job cuts at any of its locations around the world.
The tie-up is expected to close in the second quarter.
AT&T buying Nextel Mexico from NII Holdings
DALLAS (AP) -- AT&T is buying Nextel Mexico from NII Holdings for about $1.88 billion, minus the company's debt.
The deal will give AT&T Inc. companies that operate under the name Nextel Mexico and hold all of the wireless properties in Mexico held by NII Holdings Inc. That includes spectrum licenses, network assets, retail stores and about 3 million subscribers. Nextel Mexico's network covers approximately 76 million people.
The acquisition is subject to a bankruptcy auction and approvals by the U.S. Bankruptcy Court for the Southern District of New York, which is currently overseeing the restructuring of NII Holdings. The company, based in Reston, Virginia, sought bankruptcy protection in September.
The deal is also subject to regulatory approval by Mexico's telecom regulator Instituto Federal de Telecomunicaciones.
The sale is expected to close in mid-2015.
SUPREME COURT-RETIREE HEALTH CARE
WASHINGTON (AP) -- A unanimous Supreme Court is ordering lower courts to take a new look at a dispute over a chemical company's efforts to cut costs in its health plan for retired workers.
Justice Clarence Thomas wrote the court's opinion that threw out a judgment in favor of the retirees of the Point Pleasant Polyester Plant in Apple Grove, West Virginia. M&G Polymers USA LLC is the current owner of the facility.
Lower courts ruled that some retirees had been promised lifetime, cost-free health benefits.
The Supreme Court did not decide whether the courts came to the right conclusion, only that they employed faulty legal reasoning in interpreting a 15-year-old agreement dealing with retiree pensions and other benefits.
The case is M&G Polymers USA LLC v. Tackett, 13-1010.
WASHINGTON (AP) -- The U.S. Secret Service says a small drone flying at low altitude crashed into the White House complex before dawn while the president was in India.
An investigation is underway to determine its origin and identify suspects and their motive.
Secret Service spokesman Brian Leary says the device was a quadcopter and was about 2 feet in diameter. A quadcopter is an unmanned aircraft that is lifted by four propellers.
Leary says the quadcopter was flying at a very low altitude before it crashed on the southeast side of the executive mansion around 3:08 a.m. Monday.
President Barack Obama and first lady Michelle Obama were in New Delhi and not at the White House.
Leary says in a statement that the White House complex was immediately locked down until the device was examined and cleared.
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