The flagship J.C. Blair Memorial Hospital becomes the fifth hospital in the Penn Highlands system and has been renamed as Penn Highlands Huntingdon.
Nine months after entering acquisition talks, Huntingdon, Pennsylvania-based J.C. Blair Health System has cleared regulatory review and this week has joined Penn Highlands Healthcare, the health system announced.
The flagship J.C. Blair Memorial Hospital, a 71-bed, non-profit community hospital located about 120 miles east of Pittsburgh, becomes the fifth hospital in the DuBois, Pennsylvania-based Penn Highlands system and has been renamed as Penn Highlands Huntingdon.
"This affiliation represents an exciting new chapter in our growth," Penn Highlands Healthcare CEO Steven M. Fontaine said in a media release.
"Just like our other hospitals, J.C. Blair is deeply rooted in its community and is known for providing high-quality care to patients close to home," Fontaine said. "Now, through our partnership, we will not only continue to provide the services residents of Huntingdon County and surrounding communities have come to depend on, but we also will bring access to the advanced care and treatments available through Penn Highlands Healthcare."
The boards of directors of both Penn Highlands Healthcare and J.C. Blair signed a letter of intent in October.
"This affiliation will provide a great opportunity for J.C. Blair to build upon its strength as a leader in healthcare services while also maintaining our role as a major employer in the county," J.C. Blair President and CEO Joe Myers said. "An affiliation with Penn Highlands will create a sustainable model for our local hospital as well as bring additional resources and expertise to Huntingdon County."
Penn Highlands Board Chairman Dick Pfingstler said the acquisition of J.C. Blair will expand Penn Highlands's footprint strengthen its ability to recruit providers and grow its specialty services.
"Creating even more healthcare access and delivery throughout our region aligns perfectly with our longstanding mission to serve our communities," Pfingstler said.
J.C. Blair Memorial Hospital has 40 physicians on staff, and more than 400 employees, serving 45,000 residents of Huntingdon County. medical staff of nearly 40 physicians, over 400 employees, and more than 40 active volunteers, J.C. Blair is the only hospital in rural Huntingdon County, serving over 45,000 permanent county residents.
Penn Highlands Healthcare was formed in 2011. Its four other hospitals are Penn Highlands Brookville, Penn Highlands Clearfield, Penn Highlands DuBois and Penn Highlands Elk. The health system has 474 inpatient beds, and employs nearly 3,600 workers in more than 100 venues throughout 12 counties in North Central/Western Pennsylvania.
Nearly 1 in 5 people have experienced an unethical or unprofessional interaction with a physician but only a fraction of them go on to report the event.
Physician misconduct is underreported, perhaps because most people don't know how or where to file a complaint, according to a new survey commissioned by the Federation of State Medical Boards.
The Harris Poll online survey of 2,018 people found that nearly 1 in 5 of respondents (18%) have experienced what they said was an unethical or unprofessional interaction with a physician. However, only one-third of those who had a negative interaction filed a complaint, and only one-third of those filed a complaint with a state medical board, which oversees physician licensure and discipline.
"The results of The Harris Poll survey show that physician misconduct is being underreported, and a majority of Americans do not know where to file a complaint against a physician," FSMB President and CEO Humayun Chaudhry, DO, said in a media release.
"This is an opportunity to further educate consumers about the valuable role state medical boards play in these cases and ensure that if and when a patient is mistreated or harmed by a physician, they know to report that incident to their medical board," Chaudhry said.
Among the findings:
Eighteen percent of respondents said they had been treated by a physician who they believe was acting unethically, unprofessionally, or providing substandard care.
Women are twice as likely as men to have experienced physician misconduct (24% vs. 12%).
Of those who have experienced physician misconduct, only one third (33%) filed a complaint.
Men (41%) are more likely to report misconduct than women (30%),
Only one third (34%) of those who filed a complaint notified the state medical board.
Only 27% of respondents said they know how to find out if a physician has received a disciplinary action.
More than half of the respondents (51&) don't know that state medical boards are responsible for the licensing and regulating of physicians.
FSMB has mounted a public awareness campaign that relies on the search tool DocInfo.org, which explains how and where to file complaints, along with background history, including disciplinary action, on every licensed physician in the United States.
"The FSMB believes it is essential to create a safe environment for reporting, so patients feel comfortable coming forward to boards, while also empowering every member of a health care team to exercise their duty to report misconduct as well," Chaudhry said.
Coffey Health System denies any wrongdoing, but said it settled to avoid additional legal fees and 'the risk of an unfavorable outcome.'
A rural hospital in Kansas will pay $250,000 to settle whistleblower allegations that it falsified the status of its meaningful use program, the Department of Justiceannounced.
Coffey Health System, a 25-bed critical access hospital in Burlington, Kansas, allegedly submitted false claims to Medicare and Medicaid under the Electronic Health Records Incentive Program for some of the $2.2 million it collected in 2012 and 2013.
Specifically, DOJ said, Coffey Health falsely claimed that it had met program reporting requirements for ensuring EHR security.
The settlement resolves allegations in a 2016 whistleblower lawsuit filed by two former hospital employees, who will receive $50,000.
Coffey Health issued a statement denying any wrongdoing and maintains that it "properly implemented its electronic health record system, and correctly documented it."
"Nevertheless, the hospital decided to settle the lawsuit rather than continue the litigation with the government because of the additional attorney’s fees and the risk of an unfavorable outcome, which is always possible in litigation," the statement read. "Also, the hospital was concerned that the litigation with the government would distract its staff from their primary mission, which is outstanding patient care."
The absolute number of fall-related deaths for seniors ages 75 and higher increased from 8,613 in 2000 to 25,189 in 2016.
U.S. seniors 75 and older saw a threefold increase in fall-related death rates in the first decades of the new century. And the likelihood that a fall would prove fatal also increased dramatically with older seniors, according to several new studies released today in JAMA.
The absolute number of fall-related deaths for seniors ages 75 and higher increased from 8,613 in 2000 to 25,189 in 2016, according to Netherlands researchers Klaas A. Hartholt, MD Reinier de Graaf Groep.
A further breakdown of the Hartholt data showed that the overall rate of death increased from nearly 52 per 100,000 people in 2000 to 122 per 100,000 in 2016.
Adjusted for different ages, fall-related deaths increased from about 61 per 100,000 men in 2000 to about 116 per 100,000 in 2016. Among women those rates grew from 46 per 100,000 in 2000 to about 106 per 100,000 in 2016, the Hartholt study found.
The older the person, the more likely that a fall would prove fatal. Rates of death increased by age group in 2016 from 42 per 100,000 among those ages 75 to 79 compared with about 591 per 100,000 among those 95 or older, the study found.
"The reasons for these increases aren't fully known," Hartholt and Reinier de Graaf Groep wrote, "although misclassification or incomplete recording of causes of death could have resulted in overestimation or underestimation of deaths from falls."
A separate study in the same issue of JAMA looked at the prevalence and cost of traumatic injuries between 2008-2014 when compared with common acute diseases.
Of the 11.7 million hospitalizations that occurred over the six-year span, traumatic injury accounted for 5.6% of the primary indicators for admission, with an annual average cost of more than $2.7 billion, another JAMA study showed.
Elizabeth Burns, MPH, with the Centers for Disease Control and Prevention's Health Injury Center, said the findings in the JAMA studies can't be explained away simply by saying there are more older people now in the United States than there were in 2000.
"Our fall death rates adjust for the growing number of older adults in the U.S.," Burns said in an email exchange with HealthLeaders.
"We found that fall death rates are increasing in every age group but especially among the oldest age groups," Burns said. "This could be due to older adults living longer and with chronic conditions like diabetes, and hypertension. These chronic diseases can increase fall risk. Older adults are also taking more medications, some of which can increase their fall risk."
A previous CDC study had estimated that treating falls cost the U.S. healthcare system $50 billion in 2015, including $29 billion paid by Medicare, $8.7 billion paid by Medicaid, and $12 billion from other payers.
While hospitals, physicians and other providers are limited in what they can do to prevent falls outside the walls of their care venues, Burns said that educating older patients about the dangers of falls is a good start.
"Many older adults might not know they are at risk and that there are effective steps they can take to reduce their fall risk," she said.
Burns recommended that clinicians use CDC's fall initiative STEADI (Stopping, Accidents, Deaths, and Injuries) to screen for fall risk, assess modifiable risk factors, and intervene with evidence-based recommendations like reducing medications linked to fall risk or referring to physical therapy.
"It is important to talk about falls," Burns says. "Most falls can be prevented."
Rialto allegedly directed Clarksville, Indiana-based Kentuckiana Medical Center to offer personal loans to two referring doctors but never asked them to pay the loans back.
Rialto Capital Management LLC and its former affiliate RL BB-IN KRE LLC will pay $3.6 million to settle whistleblower allegations that the now-shuttered Kentuckiana Medical Center they owned and managed paid kickbacks for physician referrals, the Department of Justice said.
According to DOJ, Rialto directed Clarksville, Indiana-based KMC to proffer personal loans to two referring doctors but never asked them to pay the loans back, which investigators said "constituted a form of remuneration prohibited by both the Anti-Kickback Statute and the Stark Law."
"This recovery sends the message that healthcare providers must comply with applicable state and federal laws when billing the United States Government for services, or they will face consequences,” U.S. Attorney for the Southern District of Indiana Josh Minkler said in a media release.
Rialto, through RL BB, bought a bankrupt KMC in 2013. Under the reorganization, KMC and Rialto offered partial ownership in the hospital to referring physicians. That tactic was rejected in the bankruptcy proceedings, DOJ said, so Rialto offered personal loans to referring physicians, which they never attempted to collect.
The settlement resolves a whistleblower lawsuit filed in federal court by Abdul Buridi, MD, who will get $612,000 from the settlement.
Expanded Access provides patients with life-threatening diseases access to experimental medical products, including drugs, and biologic or medical devices.
The Food and Drug Administration on Monday announced a new initiative to help oncologists expedite unapproved and experimental therapies for cancer patients who've "exhausted available treatments."
"The first option for patients who have exhausted available treatments is to enroll in a clinical trial," Acting FDA Commissioner Ned Sharpless, MD, said in a media release. "But when that is not an option, we support Expanded Access and are exploring ways to make it easier for patients, their families and health care professionals to understand the process and how to access investigational therapies."
Expanded Access provides patients with life-threatening diseases access to experimental medical products, including drugs, and biologic or medical devices for treatment outside of clinical trials when there are no comparable or satisfactory alternative therapy options available, FDA said.
Because the treatments are not FDA approved, the agency's role in Expanded Access will be to weigh the potential benefit of an experimental treatment against the potential risks.
Under the program, physicians will ask the drug or device maker to provide the unapproved product, which the company can either approve or deny.
While the FDA said it authorizes "the vast majority" of these requests, Sharpless said that "for many patients or healthcare professionals, especially those not familiar with the Expanded Access program, the process may appear confusing or burdensome."
"Ultimately, a patient cannot submit an application for an investigational medical product; only a qualified physician is able to officially make the request," said Richard Pazdur, MD, director of the FDA's Oncology Center of Excellence.
"Through this pilot program, experienced FDA oncology staff will be available to support physicians and other healthcare professionals with their questions, assist in filling out the appropriate paperwork and acting as a facilitator for the process," Pazdur said.
The Eatontown, New Jersey-based company will pay $7.1 million to resolve criminal and civil allegations, and will cooperate with an ongoing federal investigation of price fixing in the generic drug industry.
Generic drug maker Heritage Pharmaceuticals Inc. will pay more than $7 million to resolve criminal and civil allegations related to a price-fixing scheme with competitors, the Department of Justicesaid.
The Eatontown, New Jersey-based drug company has also agreed to cooperate with an ongoing federal investigation of alleged price fixing in the generic drug industry, DOJ said.
"American consumers have the right to generic drugs sold at prices set by competition, not collusion," Assistant Attorney General Makan Delrahim of DOJ's Antitrust Division said in prepared remarks.
"It is particularly galling that, when healthcare prices in the United States are already high, certain generic pharmaceutical companies and executives engaged in collusive conduct at the expense of individuals who depend on critical medications," Delrahim said. "Heritage and its co-conspirators cheated and exploited vulnerable American patients to pad their bottom line."
A one-count felony charge filed this week in federal court in Philadelphia alleges that in 2014 and 2015 Heritage took part "in a criminal antitrust conspiracy with other companies and individuals engaged in the production and sale of generic pharmaceuticals, a purpose of which was to fix prices, rig bids, and allocate customers for glyburide, a medicine used to treat diabetes," DOJ said.
No other generic drug makers were publicly identified as part of the ongoing investigation by DOJ.
This is the third charge in the DOJ Antitrust Division's ongoing investigation of Heritage, which has already levelled charges against former CEO Jeffrey Glazer and former president Jason Malek.
The Antitrust Division also announced a deferred prosecution agreement after Heritage admitted its role in a price-fixing scheme involving the drug glyburide. Heritage will pay a $225,000 criminal penalty and cooperate with the ongoing criminal investigation.
In exchange, DOJ said it deferred prosecuting Heritage for three years, based on "substantial and ongoing cooperation with the investigation to date, including its disclosure of information regarding criminal antitrust violations involving drugs other than those identified in the criminal charge and the agreement."
In a separate civil resolution, Heritage will pay $7.1 million to resolve price-fixing allegations that DOJ said occurred between 2012 and 2015. The collusion between the drug makers and the ultimate sale of these drugs to federal healthcare programs at inflated prices are violation of the Anti-Kickback Statute and the False Claims Act, DOJ said.
The drugs included hydralazine, used to treat high blood pressure, theophylline, used to treat asthma and other respiratory problems, and glyburide, DOJ said.
Heritage Blames Former Execs
In a media release, Heritage placed the blame for the misconduct on the shoulders of its former executives, "both of whom pleaded guilty in January 2017 to felony antitrust charges; they are now awaiting sentencing, which is currently scheduled for September 26, 2019."
"The company's board of directors terminated both executives in August 2016 after learning of their antitrust conduct and discovering they orchestrated a years-long embezzlement scheme that looted tens of millions of dollars from the Company," Heritage said, adding that the company has filed a complaint in federal court hoping against both men, hoping to recover their losses.
William S. Marth, president and CEO of the Heritage Group, North America and Europe, said the drug maker was "pleased to put these issues behind us and focus on Heritage's future."
"In the years since the conduct occurred, Heritage has revamped its leadership team, strengthened its operations, and built a robust pipeline of future products that will expand the availability of generic pharmaceuticals for consumers," Marth said.
The stakeholders say private equity firm Golden Gate Capital can provide the financing needed to sustain Ensemble's 'exponential growth.'
Bon Secours Mercy Health will sell 51% of its equity in its revenue cycle management subsidiary Ensemble Health Partners to San Francisco-based private equity firm Golden Gate Capital, the stakeholders announced jointly this week.
Financial terms of the deal were not disclosed, and the companies did not say when they expect the sale to be finalized.
When the deal is finalized, Cincinnati-based Bon Secours Mercy Health will keep its partnership with Ensemble, and will hold minority owner status, with a seat on the company's board.
Ensemble will keep its management team, including founder and CEO Judson Ivy, and its headquarters will remain in Mason, Ohio.
The stakeholders said in their media release that the sale was made because Golden State Capital could provide the financing needed to sustain "the exponential growth Ensemble has achieved."
"Healthcare and the relationship between providers and payers are becoming increasingly complex, and the demand for our services is expanding significantly," Ivy said in prepared remarks.
"This partnership will support our continued growth and allow us to invest in new technologies, positioning Ensemble as a leading innovator in our field and allowing us to continue to deliver outstanding results and best-in-class services," Ivy said.
Ivy said that ceding majority ownership "is not a sale of the company, but the addition of a new value enhancing investment partner that is fully committed to our philosophy and mission."
Ivy founded Ensemble in 2014, and the company was purchased for $60 million in 2016 by Mercy Health, which merged with Bon Secoursin 2018. In the past five years, Ensemble has grown to include 3,600 employees with operations in 30 states, and more than 60 partner hospitals, the company said
Bon Secours CEO John M. Starcher, Jr., said the proceeds from the sale will be invested back into the communities it serves.
"This strategic infusion of additional capital will help Ensemble continue to expertly serve clients, while helping ensure Bon Secours Mercy Health can continue to improve the health and well-being of the communities we're privileged to serve for generations to come," Starcher said.
Joseph P. Galichia MD, the former owner of Wichita-based Galichia Medical Group PA, had reached FCA settlements with the federal government in 2000 and 2009.
For the third time since 2000, a Kansas cardiologist has agreed to a multimillion dollar False Claims Act settlement with the federal government.
This week, Joseph P. Galichia MD, the former owner of Wichita, Kansas-based Galichia Medical Group PA, agreed to pay $5.8 million to resolve allegations that he improperly billing federal healthcare programs for medically unnecessary cardiac stent procedures from 2008 through 2014, the Department of Justice said.
The allegedly false billings were sent to Medicare, the Defense Health Agency, and the Federal Employees Health Benefits Program, DOJ said.
"Patient safety is critically important," said Stephen McAllister, U.S. Attorney for the District of Kansas. "Performing medically unnecessary procedures puts patients at risk and defrauds federal health care programs."
Under the settlement, Galichia also agreed to a three-year ban from participating in any federal healthcare programs.
Galiachia sold his practice to HCA Wesley Medical Center in June, 2018.
The latest settlement stems from a whistleblower lawsuit filed by Aly Gadalla, MD, that the federal government joined in 2014. Gadalla will get $1.16 million from the settlement.
Galiachia emailed a statement to HealthLeaders, denying any wrongdoing but said he agreed to the settlement "because fighting the action was taking up far too much of his time and energy."
"Further, after nearly seven years, it simply became too costly to keep defending against these false accusations. Dr. Galichia has devoted his entire career to the practice of medicine and the cardiovascular care of many, many Kansans," the statement read. "Sadly, he feels this has been a matter of legal bullying and calls on Congress to prevent prosecutors in the future from attempting to practice medicine in the courts or by threat of legal action against well-meaning and competent physicians."
This is the third False Claims Act settlement with Galichia and GMED, DOJ said.
In 2009, Galichia and GMED paid $1.3 million to settle allegations that they submitted claims for services not provided or lacking proper documentation, DOJ said.
In 2000, Galichia and GMED paid $1.5 million to settle allegations that they submitted up-coded claims, double billed for the same services, and billed for services they didn't provide.
The SMP projects cost the government more than they saved in 2018, but OIG said the savings could be understated.
The nation's 61 Senior Medicare Patrol projects played a role in saving Medicare more than $12 million in 2018, according to a reportfrom the Department of Health and Human Services Office of the Inspector General.
The bulk of the savings came from expected recoveries of $11.9 million from the SMP's role in identifying two home health fraud schemes and one physician who provided unnecessary services and falsified records, OIG said.
The 6,935 members of the 61 SMPs in 2018 also reported $15,136 in Medicare recoveries, $5,734 in Medicaid recoveries, generated cost avoidance of $602,063, and saved beneficiaries and others $27,689, OIG said.
The Senior Medicare Patrol program was created in under the 1997 Omnibus Consolidation Appropriation Act, and is funded by grants from the U.S. Administration for Community Living.
The 61 SMPs conducted a total of 26,932 outreach events, reaching 1.7 million people, with 278,761 interactions with individual Medicare beneficiaries or their caregivers, OIG said.
The SMPs showed a 23% increase from 2017 with individual interactions in 2018 (278,761, up from 226,261). In addition, the projects reported significantly higher amounts for cost avoidance ($602,063 in 2018, up from $211,749 in 2017), while expected Medicare recoveries dropped ($15,136, down from $2 million). The number of beneficiaries contacted through outreach efforts declined to 1.7 million in 2018 from 1.9 million in 2018, OIG said.
With an operating budget of $18.1 million in 2018, the SMP projects appeared to cost the government more than they saved, but OIG said the savings it's audit found could be understated.
"We note that the projects may not be receiving full credit for recoveries, savings, and cost avoidance attributable to their work," OIG said. "It is not always possible to track referrals to Medicare contractors or law enforcement from beneficiaries who have learned to detect fraud, waste, and abuse from the projects."
"In addition, the projects are unable to track the potentially substantial savings derived from a sentinel effect, whereby Medicare beneficiaries' scrutiny of their bills reduces fraud and errors," OIG said.
