For the first time since the unsealing of whistleblower complaints around the country against Health Management Associates started last month, former HMA president and CEO Gary D. Newsome is named as a defendant. A lawsuit filed Jan. 15, 2011 in federal court in South Carolina, alleges HMA and high-ranking corporate executives, including Newsome, "devised an unlawful scheme to drive up the rate of hospital admissions from all HMA hospital ERs, without regard to medical necessity" to increase corporate profit and cheat Medicare and Medicaid programs out of hundreds of millions of dollars. The lawsuit was unsealed Jan. 3 when the U.S. Department of Justice decided to intervene.
More than two dozen orthopedic practices in the region have teamed up to form a joint corporation, hoping to avoid the financial and regulatory pressures that have driven many doctors from private practice. Called the Centers for Advanced Orthopaedics, the new consortium consists of 25 practices and 130 physicians. It spans more than 30 Zip codes of Virginia, Maryland, West Virginia, Pennsylvania and the District of Columbia. Collectively, the members bring in more than $150 million in annual revenue and employ about 1,200 people. Under the new structure, the group will share administrative, technology and marketing costs, as well as reimbursement contracts with insurers and employee benefit plans.
When the agency that runs Medicare announced last week that it would take action against doctors who prescribe abusively in its massive drug program – perhaps banning them – it raised an interesting question. What exactly constitutes "abusive" prescribing? On this point, the Centers for Medicare and Medicare and Medicaid Services (CMS) is treading carefully, refusing to get pinned down by numerical thresholds for specific drugs. Instead Medicare will consider a variety of factors in deciding whether a physician's drug choices pose a "threat to the health or safety" of seniors and the disabled.
South Carolina lawmakers say they have found a way to stop implementation of the U.S. Affordable Care Act in their state, an effort that could provide a template for other Republican-led legislatures looking to derail the federal program. The proposed measure would ban state agencies from helping carry out President Barack Obama's signature healthcare reform law and prevent federal money flowing through state coffers from being spent on it, said Republican state Senator Tom Davis. The legislation would give South Carolina oversight of insurance rates offered through its federal exchange and require healthcare navigators, which help people sign up for the healthcare benefits, to be licensed by the state, said Davis, who chairs the committee drafting the measure.
The first thing Andy Slavitt did to fix the federal government's failing health insurance website was require representatives of every contractor on the project to work in the same location 24 hours a day, seven days a week. Then, he made them all share information with each other. "The good news about a tight deadline is that you only have time for the pragmatic and the practical," said Slavitt, a leader at Optum, theUnitedHealth Group Inc. subsidiary that oversaw repairs to HealthCare.gov, the federal health portal. The government rewarded Optum's success on the project with a contract extension over the weekend.
The head of Harris County's public health system and two out-of-state physicians with administrative experience are the top candidates for Parkland Memorial Hospital's CEO job. The Parkland board of managers confirmed Monday that it narrowed its search after meeting with six potential candidates in recent weeks. A previous slate of four candidates was made public in late 2012. None got the job. The board is seeking to replace Dr. Ron Anderson. He was forced to step down as president and CEO in December 2011 amid Parkland's regulatory problems.