The former president of Philadelphia's Juniata Community Mental Health Clinic bought buildings that housed the clinics, used clinic money for renovations, and raised the monthly rent from $4,500 to $75,000.
A Philadelphia woman was sentenced to nearly seven years in prison for stealing more than $2 million from the nonprofit mental health clinic she managed, the Department of Justice announced.
Renee Tartaglione, 62, the former president of the Board of Directors of the Juniata Community Mental Health Clinic, was convicted by a federal jury in June 2017 of 53 counts of conspiracy, fraud, theft and tax crimes.
A U.S. District judge this month ordered Tartaglione to serve 82 months in prison followed by three years of supervised release.
Evidence presented at last year's trial showed that, between 2007 and 2015, Tartaglione purchased a building on 3rd Street in Philadelphia that housed the clinic and then raised the rent repeatedly, from $4,500 per month to $25,000 per month.
In 2010, Tartaglione bought a building on 5th Street, and Tartaglione used clinic money to improve it. In December 2012, Tartaglione leased the 5th Street building to JCMHC for $35,000 per month for the first two years, and $75,000 per month for the next three years; charges for both buildings that were substantially higher than market rates.
None of the JCMHC rent increases or the lease agreements were approved by JCMHC's board, and prosecutors showed that Tartaglione created fictitious documents to make the transactions appear legitimate.
Tartaglione was also ordered to forfeit $2.4 million from her scheme, and to pay $2.3 million in restitution to the Pennsylvania Attorney General's Office, which will hold the money until a successor charitable organization can be identified.
"The defendant funneled millions of dollars, meant to help economically disadvantaged people with mental health issues, into her own pockets to finance her comfortable lifestyle," U.S. Attorney William M. McSwain for the Eastern District of Pennsylvania, said in a media release.
"(This) sentence reinforces the basic precept that nonprofit organizations – especially those that provide important services to the disadvantaged – exist for the people they serve and not for the personal enrichment of their leaders," McSwain said.
The publicly operated health plan will pay for scholarships, loan repayments, and recruiting costs for primary care doctors serving Los Angeles County's safety net.
L.A. Care Health Plan will honor eight students this Thursday as the first group to receive full medical scholarships through the plan's $31 million initiative to provide more primary care physicians for the county's underserved populations.
The scholarships program is one of three grant initiatives sponsored by L.A. Care, which will also offer loan repayment for primary care physicians who agree to serve safety net populations, and which will underwrite recruiting costs for safety net clinics.
John Baackes, CEO of L.A. Care Health Plan, the nation's largest public-operated health plan, spoke with HealthLeaders Media about the initiative.
The following is an edited transcript.
HLM: This $31 million is over how many years?
Baackes: It's $31 million this year and we will repeat that for perhaps five years and segregate the money into a board-designated fund. I do not know what the draw on this will be in terms of people applying for it. My hope is that we don't spend it all in the first year, that it sits there and we create an endowment so this can go on for more than five years.
HLM: Why $31 million?
Baackes: We looked at a similar program done in San Bernardino and Riverside County through Inland Empire Health Plan, and over four years they spent $31 million and added 230-some-odd providers to the county.
We are much bigger of a county than San Bernardino, and the deficiencies at the primary care level we know now it's about 9,000 statewide. Martin Luther Kingdid a survey of their catchment area, which is representative of the communities most of our members live in, and we said let's use that number.
We're taking it out of unassigned reserves, which sit at about $477 million. We said let's segregate that amount and see what the demand is and if we're able to continue to operate at the margins we've got over the next few years, we would be able to do similar set-asides in future years. It wasn’t very scientific but it segregates the funds and now we can start the program.
HLM: Who is eligible?
Baackes: There are three elements to the program. The first one of immediate importance is that we will offer grants of up to $125,000 to organizations that employ primary care physicians that would be in our network. In other words, they are working for organizations that will serve the uninsured and other vulnerable populations. That would include every federally qualified health center that contracts with us, all Department of Health services, primary care clinics around the county, and any medical group that is contracted for the Medi-Cal population. They can apply for these funds.
So, there is the grant that goes to the organization that employs the physician. Then, we assume those physicians will also have medical school debt. We will also do payoff the loan and we will do that through our grant to a third-party organization that makes the loan payments on behalf of the student, so the student doesn't have a tax consequence.
Under the loan repayment arrangement, we want them to stay for three years. We will pay off the whole thing in monthly payments. If they leave before the three years is up, we will only have paid the monthly payments up until they time they leave. So, it's an enticement to get them to stay.
We're also trying to build a pipeline for the future. We have medical schools here in L.A. County, so we would like to support those medical schools by offering scholarships to students who commit to coming back to L.A. after they have their licensing and are practicing. We are doing eight scholarships and the students have already been picked who are coming in this year. They understand it is a free ride and they've made the commitment.
HLM: Why only primary care physicians?
Baackes: There is a demand for specialists and mid-levels. But if you don't have the primary care doctors, who are central to the Medi-Cal program, it doesn't matter about the rest of it. So, for year one, to see what the demand is, we will limit this to primary care doctors who are new to L.A. County, or who are new to the safety net. We don't want organizations to hire doctors from across the street and have them steal a doctor from another safety net provider. That is not the point.
HLM: Do you have a target number of recruits?
Baackes: Between that and the loan repayment and scholarship programs we would hope to we can get 50 doctors a year brought into the system under this program.
HLM:Why a three-year commitment from physicians?
Baackes: In talking to the institutions that employ these doctors, they said they wouldn't hire anyone who wouldn't commit to at least three years because the cost and time it takes to recruit physicians is a big investment. We said we would match that expectation, and the grant will add some oomph to that in terms of adding to the doctors' commitment.
HLM: Are international students eligible?
Baackes: Absolutely! If they are a licensed physician. How they got the medical license is not a qualifier, as long as they can be credentialed into our system.
HLM: How will you measure this initiative's success?
Baackes: MLK, in their catchment area, determined that there was a shortage of about 600 primary care doctors. It's about getting the doctors into L.A. County and placing them in the geographies that are important. So, our measurement will be volume and placement in the correct geographic areas. We don't need more doctors in Beverly Hills. We need them in South L.A.
HLM: Why is it so difficult to get primary care physicians in these underserved areas?
Baackes: One of the biggest expenses these places have that they can't afford are the replacement costs. We said of that $30,000 or $40,000 for a recruiter, use part of the grant money to pay for that and use the rest to support the salary of the doctors. The doctor is going to get paid by the organization, but they are using our grant to help them do that.
The problem they're having is that when doctors are recruited in L.A. County, Kaiser Permanente outbids everybody. The safety net clinics cannot match Kaiser's salary and benefits. Or, they can't match the teaching institutions that might hire these doctors to be in their clinics. So, if this allows that organization to boost the salaries so they can compete, then great! We've done some good.
HHS denies former secretary's chartered airplane trips were unauthorized 'as a matter of law' and says federal auditors made 'legal conclusions' that overstepped their authority.
Federal auditors are urging the Department of Health and Human Services to recoup more than $341,000 in unauthorized air travel expenses that led to the ouster of former Health and Human Services Secretary Tom Price.
"Of the 21 trips, we determined that for one trip all applicable federal requirements had been followed," HHS's Office of the Inspector General said in a 58-page audit released Friday. "The remaining 20 trips did not comply with federal requirements, including all 12 chartered aircraft trips."
"Overall, we determined that the use of chartered aircraft and identified noncompliance issues resulted in waste of federal funds totaling at least $341,000," the audit said, with a recommendation that HHS "determine appropriate administrative actions to recoup" the expenses.
Price, an orthopedic surgeon, was forced to resign last September, eight months after his appointment, after reports of his travel abuses surfaced.
HHS Deputy Secretary Eric Hargan conceded the sloppy documentation for air travel, and said HHS has since "instituted new travel review procedures applicable to all political appointees" that he called "most rigorous controls on travel in the organization’s history."
However, Hargan said auditors were not tasked with determining whether Price broke the law.
"The work of an audit is to review compliance with procedures, not make legal conclusions. As a matter of law, none of the travel at issue was unauthorized," Hargan said in amedia release.
Specifically, auditors said that Price's use of chartered aircraft was noncompliant with federal guidelines because the former secretary did not do a cost comparison to commercial airline services, did not adhere to contract requirements, and did not properly authorize the use of chartered aircraft.
"We also found specific instances of noncompliance related to the travel records for former Secretary Price and certain HHS travelers," the audit said. "Insufficient review of authorizations and vouchers and many employees' failure to complete required travel card training contributed to these instances of noncompliance."
In January, Price was named on the advisory board Jackson Healthcare, an Atlanta-based staffing firm that declined to detail his compensation.
"Nobody has as profound an understanding of the national healthcare landscape as Dr. Price," Richard L. Jackson, chairman and CEO of Jackson Healthcare, said in a January media release.
Federal officials to consider enhanced regulation and notifications from pharmaceutical companies, coupled with 'financial incentives' to ensure continued access to critically needed drugs.
Food & Drug Administration Commissioner Scott Gottlieb has formed a task force to address the nation's ongoing drug shortages.
"I'm charging the shortages task force to delve more deeply into the reasons why some shortages remain a persistent challenge," Gottlieb said Thursday in prepared remarks. "The charge to this new task force is to look for holistic solutions to addressing the underlying causes for these shortages."
The Drug Shortages Task Force will be led by Keagan Lenihan, the FDA's associate commissioner for strategic initiatives, and it will include senior officials from the FDA, the Centers for Medicare & Medicaid Services, and the Department of Veterans Affairs, Gottlieb said.
The taskforce will break into workgroups focusing on specific factors leading to the drug shortages, which will include a review of FDA's current authority over drug shortages, and reimbursement policies from CMS and other payers, Gottlieb said.
"One possibility might be to look at regulations coupled with additional financial incentives to market these critical access drugs," he said. "We want to make sure we aren't discouraging investment for manufacturing drugs that are more likely to go into shortage, and thus working against our own goals."
Gottlieb said those incentives could be coupled with requirements for sharing critical information from the pharmaceutical industry when they notify FDA about shortages.
"We'll be looking at whether it makes sense to develop a critical drugs list, or a list of essential drugs," he said. "These are medicines where it would be especially important, from a clinical perspective, to ensure an uninterrupted drug supply. For these medicines, we may want to consider more significant interventions than we currently employ to avert shortages."
A recent surveyfound that 91% of emergency medicine physicians had recently experienced a drug shortage.
Jim Augustine, MD, a board member at the American College of Emergency Physicians, said the shortages "affect almost all types of drugs used every single day in the ED—local anesthetics, injectable pain medications used for broken bones or trauma, common anti-nausea medications, heart medications, and even IV fluids used to deliver life-saving treatments."
Blair Childs, senior vice president of public affairs at Premier, welcomed the creation of the taskforce, and said it comes as 96% of hospitals in his network report that drugs shortages are a top priority.
"Drug shortages have serious implications for essential patient care, and simultaneously lead to higher prices for drugs at a time when provider margins are at an all-time low," he said. "We applaud the FDA for taking proactive action and for considering market incentives as a way to drive continued production of critical drugs."
Physicians who say they are involved in decision-making in a workplace environment that encourages collegiality, learning and respect report much lower levels of burnout.
Two studies published this week suggest that workplace culture plays a more important role in reducing physician burnout, and ensuing medical errors, than does improving safety protocols or using checklists.
One study by researchers at the NYU School of Medicine found that physicians who work in small, independent primary care practices with five or fewer physicians report dramatically lower levels of burnout than the national average.
Specifically, the NYU researchers found that 13.5% of 235 physicians who worked in 174 small, independent practices in New York City reported feeling burned out, compared with a national average of 54.4%.
While the scope of the study is limited, lead author Donna Shelley, MD, said the findings could help trace the root causes of physician burnout, which has become major concern.
“The more we can understand what drives low rates of burnout, the more likely it is that we'll find solutions to this problem,” said Shelley, a professor in the Departments of Population Health and Medicine at NYU Langone Health.
“The hope is that our research can inform ways for larger systems to foster autonomy within practices so that there is space to carve out a work environment that is aligned with doctors' needs, values, and competencies," she said, in remarks accompanying the study.
Burnout and Medical Errors
Clinical errors harm or kill hundreds of thousands of Americans each year, and physician burnout can be a contributing factor in these cases, according to the Institute of Medicine.
A study published this week by researchers at Stanford University School of Medicine found that physician burnout is at least equally responsible for medical errors as unsafe medical workplace conditions.
The Stanford researchers surveyed nearly 6,700 physicians in active practice across the nation, and 55% reported symptoms of burnout. In addition, 10% of the physicians made at least one major medical error during the prior three months.
"We found that physicians with burnout had more than twice the odds of self-reported medical error, after adjusting for specialty, work hours, fatigue and work unit safety rating," said study lead author Daniel Tawfik, MD, an instructor in pediatric critical care medicine at Stanford.
"We also found that low safety grades in work units were associated with three to four times the odds of medical error," Tawfik said.
The Stanford study found that rates of medical errors tripled in medical work units, even those ranked as extremely safe, if physician burnout was prevalent. Tawfik said burnout may be a bigger cause of medical error than a poor safety environment.
"Up until just recently, the prevailing thought was that if medical errors are occurring, you need to fix the workplace safety with things like checklists and better teamwork," he said. "This study shows that that is probably insufficient. We need a two-pronged approach to reduce medical errors that also addresses physician burnout."
Lowering Burnout Rates
NYU's Shelley said that burnout reflects "the practice culture and infrastructure" where physicians work.
"So the obvious question is: what is it about the work environment that results in low burnout rates in small practices?" she said. "It's important to study the group that's not showing high burnout to help us create environments that foster lower burnout rates."
Shelley said that physicians were asked about the "adaptive reserve" of their practices, which she described as a workplace culture that provides opportunities for growth and the ability to learn from mistakes by talking and listening to each other.
Physicians who said they're included in decisions and have control over their work environment reported lower levels of burnout.
"The good news is that a culture and systems can be changed to support primary care doctors in a way that would reduce the factors that are leading to burnout," Shelley said.
Only 16% of 302 specialty drugs examined in a new study were covered the same way by 17 major health plans, and half of the coverage decisions were consistent with FDA guidelines.
Tufts Medical Center researchers have found wide variations in specialty drug coverage among the nation's largest commercial health insurance plans.
James Chambers, lead author of a study that appears this week in Health Affairs, says his research team found that only 16% of 302 specialty drugs were covered the same way by all health plans.
About half the drugs (48%) were covered the same way by at least 75% of plans, and nearly 52% of insurance coverage decisions were in line with FDA guidance.
Chambers spoke with HealthLeaders Media about the study. The following is a lightly edited transcript.
HLM: Why did you do this study?
Chambers: The U.S. healthcare system is fragmented, particularly the commercial payer space. We tried in this study to get a better understanding of how that fragmentation and the large number of these payers translates into patient access to specialty drugs.
HLM: Your study uncovered a lot of variation between payers. How is this explained?
Chambers: We did expect to see some variation across these payers that cover different patient populations. So, these beneficiaries may have different characteristics that may lead insurance companies to tailor their drug coverage to specific patient populations.
They also would negotiate separately with product manufacturers for the prices they pay for these drugs. Given that they negotiate independently, that may also influence the differences across those decisions.
And finally, insurance companies have differing abilities to pay. Some insurance companies can simply pay more than others and could provide more generous benefits.
Now, saying all that, I didn't expect there to be quite as much variation as we found. Only 16% of the drugs we sampled were covered by each of the payers. Said another way, 84% of the drugs had some differences in coverage, meaning that some payers restricted access to the products when other payers did not.
HLM: How does this play out on the doctor/patient level?
Chambers: It has a significant impact on that interaction because it suggests that whenever a patient presents to a clinician and the clinician is judging the patient's clinical presentation and the symptoms, that they are tailoring the patient's treatment not just to the symptoms and presentation, but also to the patient's insurance coverage. This suggests that the differences across these payers is having a significant impact on the interventions that these physicians are able to prescribe for these patients.
HLM: Is this a good thing, perhaps, on a macro-economic level?
Chambers: It depends upon how you look at it. In some ways it could be seen as a good thing if it was the case that these payers are making judgements consistent with their patient population and consistent with a thorough review of the available clinical evidence that supports the decision. If that was the case, then it is a good thing.
What we've found after reviewing thousands of these coverage policies over the past several years is that payers should be more transparent in how they make those decisions. Some payers will tell us more thoroughly than others the evidence and clinical trials that they based their decisions on. It would benefit patients and physicians if payers were more transparent because these decisions have such a significant impact on patients.
Also, if every payer covered the same drugs in the same way, maybe it would take longer to really understand how safe and effective some of these products are. By virtue of the fact that we do have different payers making different decisions, hopefully tailoring their decisions to their beneficiary populations, means that maybe we could have a faster learning curve to determine if these treatments work and most importantly for which patients they provide the most value.
HLM: How should these study findings be used?
Chambers: I'd like to advance the debate about transparency in decision-making. It'd be great to start a dialog about what types of evidence the payers require when making these decisions. A better understanding for how these decisions are made has the potential to expedite patient access to these drugs, meaning that product manufacturers can develop evidence that best meets payers' requirements. Without this transparency in decision making, it's unclear just what evidence these payers are basing their decisions on.
HLM: Was any insurance company particularly generous or stingy?
Chambers: The goal of this work isn't to draw attention to which payers are most restrictive or not. We can't factor for some of the factors that may influence how restrictive they are; things like how competitive a state is, or what the budget available to those payers is.
We did find some differences across the payers and Health Care Service Corp. was one of the more generous payers in the sample. Blue Cross Blue Shield of Michigan seem to be one of the payers that most often added restrictions in its coverage.
But again, our goal was not to identify individual payers and shame those payers, as it were. It was more to determine the differences across payers and what that might mean for patients.
The potential sale comes just one year after tech billionaire Patrick Soon-Shiong, MD, acquired the nonprofit health system with a pledge to make it 'a leader in innovative healthcare delivery.'
Verity Health System said this week it may sell some or all of its six California hospitals to ease ongoing financial and operational problems.
"The top priority of Verity's board and management team is to establish a long-term, sustainable path forward for our hospitals, which are of critical importance to the communities they serve," Verity CEO Rich Adcock said in a media release.
"We are exploring a number of options to deleverage our balance sheet and address challenges our hospitals face after a decade of deferred maintenance, poor payer contracts, and increasing costs," Adcock said,
Verity's board has yet to make a final decision on a specific strategic option, but Adcock said the nonprofit health system will release information about the process when it's completed.
"As the board and management team work together to evaluate these options, the interests of our patients, employees and communities remain paramount," said Adcock, who was appointed CEO in January.
Redwood City, California-based Verity Health, formerly known as the Daughters of Charity Health System, was formed in 2015. BlueMountain Capital Management came in as a majority owner of the financially struggling health system with a pledge to contribute $260 million of capital and an option to purchase the system and convert it to for-profit after three years.
Less than two years later, however, Los Angeles tech billionaire Patrick Soon-Shiong, MD, stepped in and acquired BlueMountain's majority stake in July 2017 with a pledge to make Verity "a leader in innovative healthcare delivery, including personalized patient-centered healthcare solutions for every individual."
Last month, S&P Global Ratings revised its outlook for Verity from positive to stable.
"The outlook revision reflects an operating revenue shortfall in fiscal 2017 relative to budget expectations and ongoing operating losses through the nine-month year-to-date period ended March 31, 2018," said analyst Melanie Her.
Verity's six California hospitals are: St. Francis Medical Center in Lynwood; St. Vincent Medical Center in Los Angeles, the oldest hospital in the city; O'Connor Hospital in San Jose; St. Louise Regional Hospital in Gilroy; Seton Medical Center in Daly City; and Seton Coastside in Moss Beach.
A new study examines vertical integration of physician practices from 2007-2017 and finds considerable variation among specialties, with oncology and cardiology leading the way.
A new study this week in Health Affairs examined the consolidation of physician practices by hospitals over the past decade and found that rates of growth were highest among medical and surgical specialty practices and lowest among primary care practices.
Within the specialties, the study found considerable variation in the levels of vertical integration from 2007 through 2017, ranging from 4 percentage points in dermatology to 34 percentage points in cardiology and oncology.
Study lead author Sayeh S. Nikpay, an assistant professor of health policy at Vanderbilt University School of Medicine, spoke with HealthLeaders Media about the findings.
The following is an edited transcript.
HLM: What prompted this study?
Nikpay: I work with hospitals and how they interact with reimbursement mechanisms. I was noticing there was a lot of research on vertical integration, a lot of studies trying to quantify the effect of vertical integration on cost, quality, and access. But we really didn't know anything about the basic descriptive facts about vertical integration.
So this paper shows that this is happening systemwide, albeit more in some systems than others. It opens up a lot of questions about why.
HLM: What are the key takeaways from this study?
Nikpay: Vertical integration has been happening consistently over the past decade, and it's not just happening in specific specialties. It's happening everywhere. It's medical specialists, it's surgery, it's primary care. This is a trend that has been happening consistently.
Also, it's uncertain what vertical integration actually means. We observe clinics that are owned or affiliated with hospitals, but we don't know exactly what that means. That could mean something from tightly integrated like a Kaiser, where they are not just integrated financially. They have shared electronic medical records. They are organizationally integrated as well. Or it could be a short-term contract to fill under the provider idea of a hospital to meet a short-term need.
HLM: What explains the variations in which specialties are acquired by hospitals?
Nikpay: It could have to do with demand for specific types of services. Oncology, cardiology, these are some of the most pressing and difficult problems that patients face. So, there is a lot of demand for those services.
We can't address this in our study, but our results hint that reimbursements policy might matter. Before 2007 there were changes to the way in which oncology drugs were reimbursed. We went from being able to charge Medicare what you wanted to only being able to charge average sales price plus 6%, as part of the Medicare Modernization Act.
Later on, there were changes to cardiology reimbursement, but we don't specifically test whether those reimbursement mechanisms that targeted oncology and cardiology may have played a role in vertical integration.
HLM: Is there a common denominator in vertical integration?
Nikpay: The common denominator is that every specialty experienced some increase. We found that it ranges from an increase of four percentage points to 35 percentage points, and it's happening systemwide.
Besides the fact that it is happening across different specialties, there is this idea that vertical integration is happening in response to the Affordable Care Act and new payment models. But, we don't see jumps in vertical integration around the introduction of the ACA in 2010, nor do we see jumps in vertical integration in 2014, with the ramp up of the ACA through Medicaid expansion and the marketplaces coming on line.
"The common denominator is that every specialty experienced some increase."
—Sayeh S. Nikpay
So, our paper does not support the idea that vertical integration is a response to new payment models introduced under the ACA. This was a trend that was happening before the ACA was even passed. Now it is true that vertical integration makes it easier to deal with value-based payment reforms. However, whether that is a contributing factor, it's not a causal factor looking at it intertemporally.
HLM: Then, what is driving this vertical integration?
Nikpay: The results show it's a bit of a puzzle. People are saying it's 340B that's causing all of these oncology clinics to vertically integrate. Well, maybe it's not just 340B because we're also seeing it in surgery, where 340B discounts wouldn't apply.
Or we're hearing new payment models are causing vertical integration. Well, our paper suggests maybe not because this already appeared to be happening before these new payment models were introduced.
The more nuanced story is that there is no one silver bullet that can explain this. It's not payment policy exactly. It's not these new delivery models. It's not just 340B. These might be contributing factors, but it’s a more complex picture that may represent an industrywide trend toward a new idea; a paradigm shift in the way we deliver medical care that has grown over time.
HLM: What other trends are you seeing?
Nikpay: We can't say why, but one of the most striking findings is in general surgery. Surgeons, because of privileging, can operate in hospitals anyway, through the regular privileging system. But there could be cohort changes, and younger surgeons may be less likely to strike out on their own in private practice. They might want to be affiliated with a hospital so they can be part of the electronic health record, or not engage in the business of running a practice. Or, there have been changes to reimbursements for ambulatory surgical centers that could have made this less attractive to be in independent practice.
HLM: Given what you've seen with vertical integration in the past decade, what will the next decade look like?
Nikpay: I'll say two things. One, we are reaching a pretty high level of vertical integration in some of these specialties. You can't go up to 100%, given that there are some markets where it makes sense for practices to be community-oriented or unaffiliated. But at some point we are going to see these rates of vertical integration top out. Where that max out point is is not clear.
The other thing that matters is what is going to happen with the trajectory of healthcare policy. We've had eight years of operating in the ACA world. I'm sure that CEOs of hospitals have been operating under a certain set of assumptions and, given the surprising presidential election results, health policy has taken a different turn. The direction that it goes in will affect whether vertical integration is a good path forward or not.
HLM: Is vertical integration good or bad?
Nikpay: That's hard to say, and the study doesn't get at who's right or wrong. There is an abundance of evidence showing that vertical integration is associated with higher spending and higher prices. That is empirically known. Whether or not those spending or cost increases are justified depends upon quality, and quality we haven't plunged the depths of that question.
It's difficult to assess quality with the type of administrative data that is available. We have CMS Hospital Compare. We have other structural measures of quality, but it is hard to see if this is affecting the patient experience with coordinated care. It's even difficult to conceptualize care coordination. Until we have more targeted studies on quality, we can't do that cost-benefit analysis.
HLM: Anything else?
Nikpay: I've seen anecdotally the idea that hospitals are "gobbling up" oncology practices, and that's a little hyperbolic. It's more like it's systemwide and more hospitals are integrating with one or two oncology clinics rather than a core group of hospitals are gobbling up many practices. There are some outliers around the average, but massive consolidation is probably not correct.
A former corporate compliance officer at the four-hospital health system in Upstate New York blows the whistle on his old employers and collects a $1.9 million share of the settlement.
Health Quest Systems, Inc. and affiliated Putnam Hospital Center will pay $15.6 million to settle False Claims Act allegations that it submitted inflated and ineligible bills to Medicare, the Department of Justice announced.
In the settlement announced Monday, DOJ said that Health Quest and PHC admitted that:
From April 2009 through June 2015, Health Quest did not sufficiently document claims for evaluation and management services, which were billed two levels higher than justified by the medical records.
From April 2011 through August 2014, Health Quest submitted insufficiently documented claims for home health services.
From March 2014 through December 2014, Putnam Hospital submitted false claims for inpatient and outpatient services referred by two orthopedic physicians, a violation of the Physician Self-Referral Law.
The physicians received compensation from the hospital that prosecutors said exceeded the fair market value for the services to induce referrals to the hospital, a violation of the Anti-Kickback Statute.
LaGrangeville, NY-based Health Quest includes four hospitals and provides surgical, medical and home healthcare services in the Hudson Valley and Northwest Connecticut. Putnam Hospital Center is located in Carmel Hamlet, NY.
The settlement resolves three whistleblower lawsuits brought by former employees of Health Quest, who will share a portion of the recovered money. Whistleblower Tim Cleary, the former corporate compliance officer at Health Quest will receive nearly $1.9 million, DOJ said.
The health system issued a statement saying that it "cooperated fully with the government's investigation."
"We appreciate the opportunity to work with and finally resolve the matter with all relevant parties, including the U.S. Department of Justice," Health Quest President and CEO Robert Friedberg said. “Our intent is always to comply with government regulations."
"Today, with this matter settled, we can focus on what means the most to us: providing superior quality care for our patients," he said.
Health Quest will pay $14.7 million to the federal government, and $895,427 to the State of New York's Medicaid program, and the health system will enter into a Corporate Integrity Agreement with the Department of Health and Human Services.
Florida spine surgeon Johnny Clyde Benjamin, 52, used his Vero Beach office to manufacture counterfeit oxycodone, which was traced to the overdose death of a Palm Beach County woman.
An orthopedic surgeon in Vero Beach, Florida, was sentenced to life in prison for his leading role in a counterfeit oxycodone ring that was linked to the death of a Palm Beach County woman.
Johnny Clyde Benjamin, Jr., MD, was convicted by a federal jury in April in the 2016 overdose death of Maggie Crowley, 34, of Wellington.
Prosecutors said Crowley died after overdosing on counterfeit oxycodone pills that contained a Fentanyl analog, Furanyl Fentanyl, a powerful synthetic opioid that is much stronger than heroin or oxycodone.
A subsequent investigation determined that Benjamin, 52, was the source of the counterfeit drugs, which he was manufacturing from his Vero Beach office and distributing mostly outside of the South Florida area,prosecutors said.
Crowley was among 590 opioid deaths in 2016 in Palm Beach County, a record high. The number of people dying from fentanyl in their system rose to 310 from 91 a year before.
Crowley's family confronted Benjamin at the sentencing hearing in Fort Lauderdale on Friday, where they made emotional pleas for a lengthy sentence, as TCPalm.com reported.
Crowley's husband, Shaun Crowley, told the court Benjamin was "an absolute monster."
Her parents asked the judge to sentence Benjamin to life in prison.
"Now that Maggie is gone, there is a bottomless, empty hole in my soul," said her mother, Margaret Divita.
"There hasn’t been a day gone by we don’t cry for her," said her father, Joseph DiVita, according to media accounts.
Benjamin's attorney Philip Reizenstein told local media that he would appeal the conviction and sentence.
