A Lakewood, WA oncologist and his wife face 20 counts of healthcare fraud and related charges for an alleged scheme to overbill Medicare and other government and private health plans by about $1.7 million for larger amounts of medicine than were delivered to patients, the Department of Justice said.
Alfred Hongleung Chan, 63, and Judy Yuan Chan, 62, face up to 20 years in prison if convicted of the charges, which include obstruction of justice and money laundering. The indictments were handed up earlier this year by a federal grand jury, and unsealed this week in U.S. District Court in Tacoma. Arraignment is scheduled for July 29.
The charges stem from a whistleblower False Claims Act suit by a former employee at the Chans' Lakewood clinic. The indictment and the civil suit allege that, beginning in 2006, Alfred Chan would make patient treatment notes on individual slips of paper which were given to his nurse. The notes specified the amount of drugs to be provided to a specific patient. After the nurse had provided the drugs to patients, the slips of paper were returned to Chan who shredded them. The doctor then made entries into a "Superbill" form, ostensibly recording the amount of medications the patients had received, DOJ said in a media release.
Evidence in the case, however, allegedly indicates that Alfred Chan recorded more medication administered than actually received by the patient, and claimed more time spent administering the medication than actually occurred.
Judy Chan then allegedly prepared the bills for Medicare and other government and private healthcare programs, using the inflated amounts, substantially increasing the amount of money owed to the Chans' clinic for medication.
The government alleges the scheme illegally boosted the clinic income by $1.7 million. Alfred Chan made false entries on patients' medical records so that they matched the billings. The records indicated that patients had received larger doses of various drugs than they had actually received, DOJ said.
The false statement, obstruction, and money laundering charges relate to steps allegedly taken by the Chans to hide their assets once they became aware of the government investigation. On a financial disclosure form required by the government, the couple didn't declare bank and brokerage accounts and properties owned by them. They allegedly transferred assets to shield them from the reach of law enforcement, DOJ said.
In an effort to reduce emergency department crowding, nine associations representing ED healthcare providers have signed a consensus statement that proposes standardized definitions for six common ED metrics.
Under the consensus statement, for example, an emergency department is defined as "a dedicated location serving an unscheduled patient population requesting emergency assessment," and triage time is defined as "the time that rapid or comprehensive triage is initiated by a registered nurse or institutionally credentialed provider."
AnnMarie Papa, RN, president of the Emergency Nurses Association, said that a standard set of metrics are needed to get everyone on the same page when looking for solutions to the nation's worsening ED crowding issue.
"Addressing it is one of ENA's top clinical priorities, but we can't solve a problem if we can't agree on how to quantify it," Papa said in a media release. "This consensus statement is a first and important step in reducing crowding and boarding in emergency rooms and helping us provide better and faster care to our patients."
Wait times in emergency departments are surging. The practice of boarding is a symptom of gridlock and prompts patients to leave the hospital without proper care.
ED transfer of care from pre-hospital providers' time;
ED triage time; and
ED treatment space time.
Robi Hellman, clinical practice manager, American Association of Critical-Care Nurses, said common metrics are needed because the sickest patients enter the nation's healthcare system through the ED. "Universally defined time stamps and intervals will ensure accurate patient hand-offsand consistency in health records," Hellman said.
The other organizations that signed onto the final statement are: the American Academy of Emergency Medicine; American Academy of Pediatrics; American College of Emergency Physicians; American Nurses Association; Association of periOperative Registered Nurses; Emergency Department Practice Management Association; and National Association of EMS Physicians.
A Toms River, NJ, man admitted to a federal judge this week that he posed as a physician and illegally treated hundreds of elderly patients and prescribed medicine as part of a Medicare fraud scheme.
Patrick Lynch, 54, pleaded guilty in U.S. District Court in Trenton to one count each of healthcare fraud and aggravated identity theft in connection with the scheme he orchestrated through Toms River-based Visiting Doctors of New Jersey. Federal prosecutors said Lynch conducted hundreds of visits with elderly, home-bound patients and billed them to Medicare.
"Patrick Lynch defrauded a government program designed to help Americans most in need of health support," U.S. Attorney Paul J. Fishman said in a media release. "To further his deception, he misused the identities of skilled professionals and put elderly patients at risk. Homebound individuals with pressing medical concerns should not have to worry that they are receiving substandard care from untrained hands."
Documents and statements connected with the investigation showed that Lynch created Visiting Doctors of New Jersey to provide care for elderly home-bound patients in the Monmouth and Ocean County areas. He hired licensed physicians and nurses to conduct patient visits but they quit when Lynch failed to pay them. So Lynch then posed as the medical professionals, using their names and government-issued ID numbers to write prescriptions and submit billings to Medicare, the Department of Justice said.
The healthcare fraud charge carries a maximum penalty of 10 years in prison and a fine of $250,000, or twice the gross gain or loss from the offense; the aggravated identity theft charge carries a mandatory sentence of two years in prison, to run consecutive to any sentence imposed on the healthcare fraud charge.
Sentencing is scheduled for Oct. 17. The amount that Lynch will be required to repay in restitution is still being determined, DOJ said.
"The threat to the public well being in this case is considerable," Michael B. Ward, Special Agent in Charge of the FBI's Newark field office, said in a media release. "Without sufficient training and lacking minimal credentials, Patrick Lynch attempted to profit by presenting himself as a licensed medical professional, conducting home healthcare visits with elderly patients, writing prescriptions, and falsely billing Medicare. His actions placed these unsuspecting patients at undeterminable risk."
An American Hospital Association survey of 820 hospitals across the nation found that almost all of them reported a drug shortage in the last six months, and nearly half of them reported 21 or more drug shortages.
That growing shortfall has prompted some patients to take less-effective drugs or delay treatment because of drug shortages, the survey showed.
"The number of drugs in short supply is increasing at an alarming rate and hospitals are working diligently to reduce the impact to the patients they care for," AHA President and CEO Rich Umbdenstock said in a statement Tuesday that came with the survey's release. "Clinicians need more notice about drug shortages so they have time to act to ensure that patient care is not disrupted."
Earlier this year Premier Inc., a hospital purchasing alliance, reported that the near-crisis shortage of drugs had reached a 10-year high. The lack of chemotherapy, sedation, and pain relief medications endangers patient safety and costs hospitals more than $200 million annually for higher priced substitutes, a Premier survey found.
The AHA survey found that in the last six months:
Hospitals report that they have delayed treatment (82%) and more than half were not always able to provide the patient with the recommended treatment
Patients got a less-effective drug (69%)
Hospitals experienced drug shortages across all treatment categories
Most hospitals rarely or never receive advance notification of drug shortages (77%) or are informed about the cause of the shortage (67%)
The vast majority of all hospitals reported increased drug costs as a result of drug shortages
Most hospitals are purchasing more expensive alternative drugs from other sources
The AHA made public the results of its survey at a Capitol Hill press conference that also endorsed bipartisan legislation to address the drug shortages. U.S. Reps. Tom Rooney (R-FL) and Diana DeGette (D-CO) are cosponsors of the "Preserving Access to Life-Saving Medications Act," which they said will improve patient safety by reducing shortages of life-saving drugs.
The bill would expand existing law to combat drug shortages by:
Requiring manufacturers of all prescription drugs, including biologics, to notify the FDA of any discontinuance or interruption in the production of a drug at least six months in advance;
Requiring manufacturers to notify the FDA as soon as possible in the event of an unplanned discontinuance or interruption;
Instructing FDA to publish these notifications and any drug shortage on its website, and work to distribute this information to appropriate healthcare providers and patient organizations; and,
Directing a GAO study to examine the possible causes of drug shortages, including manufacturing problems, breakdown in supply chains and delivery systems, and restrictive regulatory requirements.
The AHA, American Society of Clinical Oncology, American Society of Health-System Pharmacists, and Institute for Safe Medication Practices have endorsed the bill.
A former chief financial officer who pleaded guilty to bilking about $200,000 from hospitals in Ohio and Connecticut was sentenced Monday to a maximum 33 months in a federal prison, three years of supervised release, and ordered to pay restitution, the Department of Justice said.
William Roe, 55, had been the CFO at St. Rita's Hospital in Lima, OH, from 2006-2009, and the CFO of Danbury Hospital in Danbury CT from 2009-2010.
From 2008-2010, Roe used a company he'd created called Cycle Software Solutions to defraud both St. Rita's Hospital and Danbury Hospital by billing them for $75,000 and $95,000, respectively, for nonexistent software and services. Roe also billed Danbury Hospital for another $25,000, but that payment was stopped, DOJ said.
On Jan. 4 Roe pleaded guilty to one count of wire fraud.
On Monday, U.S. District Judge Vanessa L. Bryant ordered Roe to pay restitution of $75,000 to St. Rita's Hospital, and $141,166 to Danbury Hospital. The Danbury Hospital restitution figure includes an additional $46,166 that Roe improperly received, DOJ said.
Roe was arrested on Aug. 17, 2010, and had worked as an adult day care aide for Goodwill Industries after he was released on bond.
That bond was revoked in March when Roe violated the terms of his release and used the Internet. Prosecutors said Roe sent his probation officer an email using his wife's email account, and under his wife's name.
In a six-page, single-spaced letter filed with the court, Roe asked Bryant for leniency, and said he came before her "a broken man." He blamed his downfall on a convergence of problems at work, personal family substance abuse and other domestic issues, financial strains, and an extra-marital affair.
"I have been financially devastated by my crime. I have ruined my reputation in an industry that I loved and was good at," Roe said in his letter. "I ask that you be lenient with me and let me return to society as soon as possible. I want to be a productive member of society. I want to see my grandchildren grow up. I know I have a financial penalty as well and want to begin repaying that as soon as possible. I would never consider doing anything remotely like this again."
However, David B. Fein, the U.S. Attorney for Connecticut, said in the government's sentencing memo that Roe created a convincing façade to mask his criminal conduct. "To be sure, at least one person has described Roe as a 'very generous man who would do anything for anyone,' and Roe himself states that his conduct was 'totally out of character' for him. But it is precisely this facade of a good and generous character that allowed Roe to get away with his criminal actions for two years," Fein said.
The prosecutor noted that Roe had complained that he was underpaid, even though he owned two houses and earned more than $500,000 in 2009 at the height of the scam.
"Plainly Roe's moral compass was askew, and his conduct in stealing money not for need, but for what can only be interpreted as sport is deserving of a sentence at or near the top of the agreed-upon guidelines range," Fein wrote in the memo.
Bryant apparently agreed, and sentenced Roe to the maximum 33-month prison term under the guidelines.
Physician alignment and incentive challenges could prove to be a major hurdle for healthcare providers who want to take part in accountable care organizations.
Richard C. Johnston, MD, an internist with Dallas-based Medical Clinic of North Texas, says hospitals will find ACOs to be a tough sell for skeptical physicians. "The main stumbling block in physician integration is alignment of incentives. That, and who controls the dollars. Who does CMS write the check to?" Johnston tells HealthLeaders Media.
"Since most of the savings in the ACO comes out of limiting hospitalizations and ER visits and readmissions, there is a natural conflict there. If hospitals start to have their reimbursement cuts and if their admissions fall it is going to be difficult to sustain their infrastructure. So, who gets the money and distributes it," he says. "If the hospital is getting the money I would think they would probably try to protect their profitability first and the physicians would be left out there."
WEBCAST: Cultivating Physician-Hospital Alignment in the ACO Era When: July 20, 2011 Register today for this live event and webcast
A recent survey of 882 hospital administrators and physicians by recruiters AMN Healthcare found that 42% said physician alignment was the most serious obstacle to forming an ACO, followed by a lack of capital (38%), a lack of integrated IT (31%) and a lack of evidence-based treatment protocol data (25%).
David A. Spahlinger, MD, a senior associate dean for clinical affairs at the University of Michigan Medical School, says he's not surprised that physician alignment is becoming a sticking point.
"Yes there are some capital investments you have to make for IT and there are staffing issues, but in the end it's really the alignment of the parts in how we are going to care for patients," he says.
For most healthcare professionals Spahlinger says it's a matter of perspective.
"Physician alignment for health systems is 'how can we make sure the medical staff is on the same page and working together to accomplish system goals?' Every hospital administrator struggles with that," he says. "The physicians say 'Well that is the hospital's goal not our goal. What's in it for us?' That is a major problem in most organizations, and even in the so-called integrated organizations. It's not an easy goal to align everyone in an organization around system goals."
WEBCAST: Cultivating Physician-Hospital Alignment in the ACO Era When: July 20, 2011 Register today for this live event and webcast
The challenge of aligning disparate groups around a set of unified goals is challenging for any organization, Spahlinger says, and healthcare is no exception.
"With the way they have it laid out in the proposed rules, there are significant hurdles before you see the savings, and it is not clear how much savings you'll get back versus the investment you make," he says. "In order to really accomplish these goals you have to have everybody working on the same page."
Johnston says ACOs should be "driven" by primary care physicians. "And then the primary care group needs to establish relationships with specialists and hospitals and try to get everybody working together to deliver better faster cheaper care," he says. "That is the goal. It is easy to say, but man!"
Medical Group Management Association and its credentialing and standard-setting body American College of Medical Practice Executives on Monday said it has named a Wisconsin primary care physician as its new president/CEO.
Susan Turney, MD, an internist, will take over in early October, succeeding William F. Jessee, MD, who retires in September after 12 years at the associations. Turney, a fellow in ACMPE, was picked by the boards of directors after a year-long national search.
She will oversee the strategy and operations of MGMA, ACMPE, and their affiliated organizations. With 22,500 members, MGMA is the largest national professional association representing medical practice managers and executives.
Turney has been CEO and executive vice president of the Wisconsin Medical Society since 2004. She founded and chaired the Wisconsin Statewide Health Information Network to promote patient-centered healthcare, and advance the use of information technology to improve healthcare quality and efficiency. She also co-founded the Wisconsin Health Information Organization. Along with her clinical practice, Turney was medical director for patient financial services at Marshfield (WI) Clinic.
Turney was the 2005-06 MGMA board chair and has served in other board positions. She has served on the National Quality Forum, and fulfilled many other appointments from the Wisconsin governor and the secretary of the U.S. Health and Human Services.
She holds a medical degree and a master's of science degree in administrative medicine from the University of Wisconsin School of Medicine and Public Health. She served her internal medicine residency at Marshfield Clinic/St. Joseph's Hospital.
The Great Recession offers few silver linings, but the economic downturn has played a huge part in alleviating the shortage of nurses in this country.
Simply put, nurses haven’t been able to afford to retire.
If your nurse retention strategy is built around the recession, however, you may be in trouble. A 2011 survey from healthcare recruiters at AMN Healthcare found that one-quarter of the 1,002 registered nurses surveyed say they will look for a new place to work as the economy recovers – up sharply from the 15% who said they’d look for a new job in a 2010 survey.
The 2011 Survey of Registered Nurses: Job Satisfaction and Career Plans, also found that while nurse career satisfaction was high at 74%, actual satisfaction with the role RNs now hold was at 58%, down from 66% in the 2010 survey. Most alarmingly, the survey found that 32% of nurses plan to take steps in the next one to three years that would take them out of nursing, up from the 26% who said they would take those steps in the 2010 survey.
And, regardless of what the economy is doing, the simple fact is that nurses are getting older. The American Association of Colleges of Nursing cites studies that show that the average age of RNs in the United States is expected to reach 44.5 years by 2012. Nursing can be stressful, both mentally and physically, with new demands and expectations piled on almost daily.
Marcia Donlon, RN, vice president medical center/CNO at Holy Family Memorial in Manitowoc, WI, says she is not surprised by the findings.
“When it hits you in the face all at once it is like what are we going to do. All of a sudden there is going to be a huge exodus,” she says. “It just makes sense if you’ve been in nursing for any length of time and you look around the room and you see a lot of people in the same age group.”
As the role of the nurse changes to incorporate more knowledge of information technology, there is a learning curve associated with age, Donlon adds. Also, long hours and long shifts can be a turn-off for older nurses.
"The younger nurses really like [longer shifts]. They don’t get as tired. But a lot of the older nurses will tell you they can’t do them. Another thing is the number of morbidly obese patients. Nurses get hurt because you are trying to lift and turn and care for people who are over 400-500 pounds,” Donlon says.
These are significant demands that have to be overcome, but Donlon says hospital executives – and the nurses themselves – who are willing to compromise, may be able to minimize the exodus.
“It’s really a shift in our thinking about what the possibilities are,” Donlon says. “Why would I want one of my most valuable experienced nurses to retire at 60 when he or she is most valued by patients and colleagues.”
Hospital leaders can start the process by asking nurses a simple question: What is it going to take to keep you here?
“Nurses who want to work 4 hour shifts? Bring them on. Maybe I want to go to Florida for the winter but I will work all summer, so give me my three months off. Maybe I don’t want to cut down, I just want to shift things,” Donlon says. “Here’s another thing, working from home. There is resistance to that. How do I know what you are going to be doing at home? We have to get over that.”
Nurses have to be willing to explore new roles, too, and not necessarily let their past job experiences dictate their future job potential. “We as nurses trap ourselves, sometimes saying ‘I’ve worked on Med/Surg for 20 years what else can I do?’ But there are so many things we can do,” Donlon says.
Remember, however, that things like flexible schedules, shifting duties, mentoring programs, and team-care projects – no matter how well designed -- are only stop-gap measures. They cannot change the inalterable fact that America’s nursing workforce is graying along with the people for whom they provide care. At some point, they’re going to clock-off, no matter what’s going on in the economy.
A federal appeals court has temporarily blocked Phoebe Putney Health System Inc.'s proposed $195 million acquisition of rival HCA's Palmyra Park Hospital, in Albany, GA.
The U.S. Court of Appeals for the 11th Circuit in Atlanta issued an injunction that was sought by the Federal Trade Commission in its antitrust complaint against the two hospital systems. The appeals court order late Wednesday afternoon was handed down minutes before the two hospital systems were preparing to finalize the deal. The appeals court agreed to an expedited hearing for the case.
"We are gratified by the 11th Circuit's order and are pleased that Phoebe Putney will not be permitted to complete its acquisition of Palmyra Park Hospital while the Eleventh Circuit considers our appeal," FTC Bureau of Competition Director Richard Feinstein said in a media statement. "We intend to show that the proposed transaction – which will lead to a monopoly in the Albany, Georgia area – will result in higher health care costs for local patients and should not be immune from federal antitrust scrutiny."
In its complaint, the FTC alleged that PPHS constructed an elaborate scheme that used the Hospital Authority of Albany-Dougherty County, GA as a "straw man" to "cloak private, anticompetitive activity in governmental guise in the hopes that it would exempt the acquisition from federal antitrust law."
"There is abundant evidence, and the defendants do not dispute, that Phoebe Putney's acquisition of Palmyra, its only rival hospital in the Albany, Georgia area, will create a monopoly," Feinstein said earlier this year. "This will result in dramatically higher healthcare costs for citizens of that community. The deal was specifically structured to avoid antitrust enforcement. We will immediately appeal the court's decision that the acquisition is immune from antitrust scrutiny."
However, U.S. District Judge W. Louis Sands in late June ruled that the PPHS was immune from federal antitrust liability under the FTC Act and the Clayton Act.
Earlier this year the FTC voted 5-0 to issue the administrative complaint and authorize staff to file a complaint for preliminary injunction in federal district court. The evidentiary hearing is scheduled before an administrative law judge at the FTC on Sept. 19.
A statement issued by Phoebe Putney reads in part, "While the Hospital Authority has been prepared to sign all necessary documents for the purchase by the close of this week, we are not surprised by the 11th Circuit action at this time. We are, however, pleased that the 11th Circuit has also agreed to expedite the appeal process. "
The nation's hospitals treated more than 127 million in-patients, employed more than 5.4 million people, and generated more than $2.2 trillion in economic activity in 2009, an American Hospital Association report says.
The report – Economic Contribution of Hospitals Often Overlooked – notes that hospitals provided outpatient care for 515 million people, performed 27 million surgeries, and delivered 4 million babies in 2009, and that the overall healthcare sector created an average of 24,000 new jobs a month that year, despite the recession.
"Every year, hospitals provide vital healthcare services like these to millions of people in thousands of communities. However, the importance of hospitals to their communities extends far beyond healthcare," AHA said in the report. "The healthcare sector is an economic mainstay, providing stability and even growth during times of recession."
Hospitals support one of nine jobs in the nation, and the overall healthcare sector is one of the largest sources of private-sector jobs in the nation, spending about $342 billion on goods and services from other businesses. "With these 'ripple effects' included, each hospital job supports about two more jobs and every dollar spent by a hospital supports roughly $2.30 of additional business activity," the AHA report said.
The report includes a state-by-state breakdown of economic activity generated by hospitals.
