Covenant Medical Center in Waterloo, IA, will pay $4.5 million in fines to resolve allegations that it allegedly violated the False Claims Act, according to the Department of Justice.
Federal investigators had alleged that Covenant submitted false claims to Medicare by having improper financial relationships with five physicians that violated the Stark Law.
Covenant issued a statement noting that it admitted to no guilt in the settlement, and that its decision to resolve the case was based only on business concerns about the expense and uncertainty of pursuing the protracted litigation.
Prosecutors say Covenant paid commercially unreasonable compensation—far above fair market value—to five employed physicians who referred their patients to Covenant for treatment. These physicians were among the highest-paid hospital-employed physicians not just in Iowa, but in the entire United States.
"This payment is the largest ever related to claims of healthcare fraud in the Northern District of Iowa," said US Attorney Matt M. Dummermuth of the Northern District of Iowa.
Covenant issued the following statement: "From the beginning of this inquiry, Covenant Medical Center fully cooperated with the government and provided extensive evidence to the government that the physician compensation was consistent with the approved compensation plan, was based on work personally performed by the physicians, and reflected their exceptionally high level of productivity. The government never disputed Covenant's assertion that the compensation paid to the employed physicians was based on work performed by these highly productive physicians.
"This settlement is not an admission of wrongdoing; Covenant believes the government did not produce any evidence that Covenant had engaged in wrongdoing or illegal conduct. Covenant Medical Center made a business decision to settle to avoid the uncertainty of litigation, disruption, and high expense associated with protracted litigation with the government, despite our firm belief that Covenant's compensation to its physicians was reasonable and fell within fair market value. Covenant will continue to maintain its robust voluntary compliance program and will not be subject to an oversight or monitoring agreement by the Office of Inspector General as a result of this settlement," according to Covenant.
Lack of sufficient safety gear, infection control training, and knowledge of post-exposure procedures are jeopardizing H1N1 readiness in hospitals in at least nine states.
That's the conclusion from a survey of 190 health facilities sponsored by the California Nurses Association and the National Nurses Organizing Committee.
The two groups released a list of demands they call "The Nurses Swine Flu Safety Agenda," which seeks to pressure hospitals to require more strict adherence to federally recommended infection control guidelines.
Among the findings:
Nurses at more than 25% of the hospitals said there is inadequate ability to isolate H1N1 patients, increasing potential infection transmission to others.
Nurses at 15% of hospitals do not have access to proper N95 respirator masks, also potentially exposing nurses and patients to infection. At 40% of the hospitals participating in the survey, nurses said they are expected to re-use their masks, in violation of current policy guidelines issued by the Centers for Disease Control and Prevention.
At 18% of the hospitals, registered nurses reported that nurses have become infected, and a registered nurse who practiced in Sacramento has died.
The survey was conducted at hospitals in Arizona, California, Florida, Illinois, Maine, Minnesota, Nevada, Pennsylvania, and Texas, and comes just after the President's Council of Advisors on Science and Technology suggested two million Americans might be hospitalized, and 90,000 could die in an H1N1 outbreak this year in the U.S. That's three times the usual number of deaths during a typical influenza season.
"These continuing problems increase the risk that many hospitals will become vectors for infection, with inadequate patient protections leading to a spread of the pandemic among other patients, their friends, family and caregivers, and the surrounding community," warned Deborah Burger, co-president for the CNA and NNOC.
"What we're hearing from around the country is dangerous to patient health and safety, but with smart and clinically appropriate leadership, we can fix policies in time for the upcoming pandemic."
Unfortunately, CNA officials say, hospital administrators are doing little to fortify their preparedness.
For example, one registered nurse in Chicago, Brenda Langford, says hospital managers have been presented with copies of the survey findings, but "have not moved to change our practice to be in compliance" with CDC recommendations.
"If the Cook County Health and Hospital System won't make these needed changes and the Cook County Department of Public Health won't support our efforts to protect nurses and the public, it is left up to the NNOC to make sure these needed protections are implemented," says Langford.
Survey respondents at the 190 hospitals reported that in general, nurses have not been properly fitted for masks and have not been given adequate training on how to identify infected patients and procedures for caring for them.
At 65% of the facilities, nurses have not been guaranteed adequate sick leave if they become ill while caring for a patient, which would result in a penalty for staying home while they were potentially infectious.
The CNA/NNOC says it represents 86,000 registered nurses in 50 states.
Since he was elected in 1962, Sen. Edward Kennedy (D-MA), who died Tuesday, has been a tireless fighter for healthcare reforms. But with his passing, will the reforms he had long sought become reality without his leadership? Maybe—but the atmosphere of bipartisanship that he had promoted with earlier legislation will be likely frayed without his presence.
He introduced his first bill calling for universal health coverage in 1970. In 1980, healthcare reform became central to his presidential campaign—underscoring the idea that not just coverage but escalating health costs could impact family and national budgets. In 1993, he took up the cause again when President Clinton called for reforms to the healthcare system.
While those wars may have been lost, he was winning incremental battles in what he saw as improvements to the healthcare system—looking for bipartisan support wherever he could. In 1996, for instance, he worked across the aisle with Sen. Nancy Kassebaum (R-KS) to address health privacy issues and make health insurance more portable through the Health Insurance Portability and Accountability Act, which is better known as HIPAA.
While Sen. Orrin Hatch (R-Utah) has been continually on the other side of the political spectrum from Kennedy, they worked together to establish creation of the Children's Health Insurance Program (CHIP), among other pieces of legislation.
On Wednesday, many of the leaders on Capitol Hill who worked with Kennedy over the years praised him for his bipartisan efforts to get healthcare legislation through. Hatch, in his statement, said that when he first came to the Senate, he "was filled with conservative fire in my belly and an itch to take on any and everyone who stood in my way, including Ted Kennedy," he said.
However, while they often disagreed on most issues, "once in a while we could actually get together and find the common ground, which is essential in passing legislation." While they alternated as chairman and ranking members of the Senate Labor Committee, now called the Health, Education, Labor and Pensions (HELP) Committee, as the party majorities switched, they were able to "come together in a bipartisan fashion to craft some of this nation’s most important health legislation."
Sen. Judd Gregg (R-NH), who also alternated as chairman and ranking member with Kennedy on the HELP Committee, said that Kennedy "was always willing to not only reach across the aisle, but had the unique ability to pull people together to get things done—with both substance and a great sense of humor."
Some of that bipartisanship support was missing during the hearings this summer on the healthcare reform bill considered by the HELP Committee, chaired by Kennedy's friend, Sen. Chris Dodd (D-CT). While 160 Republican amendments were included in the final bill approved last month, the GOP members, who continually voiced displeasure about not being included in the initial drafting of the bill, voted against it. (The bill passed on party line 13-10.)
The committee's ranking minority member, Sen. Michael Enzi (R-WY), who had worked with Kennedy on earlier bipartisan health legislation, had commented about the process that "I don't think Sen. Kennedy would have treated me this way."
Sen. Max Baucus (D-MT), in continuing meetings with Senate Finance Committee members, has been seeking bipartisan support for its healthcare reform package. But whether he will be able to hammer out that support in the Senate and on Capitol Hill is proving to be a struggle and may more difficult no doubt without Kennedy's presence.
Meanwhile, many of the healthcare groups that Kennedy had worked with over the years mourned his passing. The American Medical Association praised his work as "a champion for America's patients—working until the end to make improvements on their behalf." In particular, they cited his work to expand "access to healthcare for children and to secure fair health coverage for the mentally ill."
The American Hospital Association said that he was a "friend to hospitals, patients and communities in Massachusetts and across the country" where he fought "to improve healthcare and expand access and coverage for all."
"His extensive knowledge of the healthcare system and the inner workings of Congress, and his ability to build consensus will be greatly missed as discussions continue on how to best improve healthcare," AHA said.
Hospitals may gain as much as $16 billion over a decade from the Obama administration's proposals to overhaul the healthcare system. Middle Tennessee-based Community Health Systems, HCA, and other hospital groups would receive $171 billion over 10 years in reimbursements for the newly insured under legislation to provide medical coverage for all U.S. citizens, the American Hospital Association said in a report to industry and lawmakers.
Sen. Edward M. Kennedy lived 15 months with an incurable brain tumor, a little longer than usual for a patient in his late 70s. Perhaps equally important is that Kennedy lived those months well—able to work almost to the end, to sail the choppy New England waters he adored, to help elect a president he supported, and even to give him a dog. Time is important to any cancer patient. Quality of life, not just how much life they can squeeze out, is increasingly the focus for people with a terminal illness, cancer specialists say.
The battle among pharmacies to win big corporate accounts with promises of lower costs and improved efficiency has entered a new phase. Walgreen Co., announced it will offer prescription drugs directly to Caterpillar Inc., for its workers and retirees, launching a program that will parallel the one Wal-Mart Stores Inc., already has with the heavy equipment manufacturer. Meantime, Caterpillar announced it had signed a two-year contract with Wal-Mart, in effect extending the pilot program on prescription drugs that has been in place since September.
A wave of bleak news about the stagnant economy, led by a projection that the federal deficit will grow by $9 trillion over the next decade, has given opponents of President Obama's expansive domestic agenda a new opening to attack his proposed healthcare and energy overhauls. As part of its fiscal midyear review, the Obama administration said the new deficit estimate is $2 trillion more than it had projected in February when its budget initially was outlined.
Sen. Kent Conrad (D-ND), a pivotal lawmaker in the healthcare debate, wants to deliver coverage to the uninsured by starting up new cooperatives modeled on rural electric cooperatives that were founded during the Great Depression. But rural electric cooperatives have a mixed track record, experts say. They brought electricity to millions of rural Americans who lacked it in the 1930s and today serve about 14% of Americans. But after 75 years, the rural electric cooperatives still rely heavily on federal credit subsidies, have weak balance sheets, and, some studies suggest, operate less efficiently than privately-owned utilities.
Most people don't have much say over which health insurance plan they get, and the big healthcare bills introduced in Congress this year wouldn't do much to change that. The controversial public option—a new, government backed health plan—would be an option only for a minority of Americans. Most people who get coverage at work would still be covered at work under the health reform bills, according to the Congressional Budget Office.
The Democratic proposals being debated this year could lead to the biggest shift in federal healthcare policy since the advent of Medicare in the 1960s. That raises an interesting question: What did the debate over Medicare look like? There was a big fight—and President Lyndon B. Johnson suppressed the true projected costs of the program as he pushed it through Congress, according to James Morone, a Brown political scientist.
