HealthLeaders reached out to all nine hospitals that received an 'F' from The Leapfrog Group and offered them an opportunity to respond to the failing grade. Three hospitals responded.
Of the more than 2,600 acute care hospitals scored in The Leapfrog Group's spring 2019 hospital safety grades, nine received an "F," placing them in the bottom 1% of hospitals scored.
Some hospitals that made the list conceded that they faced problems, but said they're working to correct issues identified by The Leapfrog Group survey. In some instances, the hospitals noted that they receive passing grades in performance audits from other sources, and that their lack of participation in The Leapfrog Group survey may have played a role in their failing grade.
In a statement sent to HealthLeaders, Leapfrog Group said its Hospital Safety Grade is calculated predominantly with data from the Centers for Medicare and Medicaid Services.
While hospitals do not receive an "F" if they did not participate in the survey, Leapfrog said participation in the survey "gives hospitals the opportunity to report additional information about their safety measures."
Patients admitted to a "D" or "F" hospital face nearly double the risk as those admitted to an "A" hospital, according to Leapfrog's metrics.
HealthLeaders reached out to all nine hospitals and offered them an opportunity to respond to the failing grade. Three hospitals responded, and their statements are listed below.
1. Hurley Medical Center
"As a premier public hospital, Hurley Medical Center remains committed and dedicated to patient safety as a continuous goal, and constantly evaluates and measures processes in place, along with best practices to continuously improve the safety of the comprehensive services we provide to patients," said Laura Jasso, administrator of marketing and community relations for Hurley Medical Centerin Flint, Michigan.
"Although we declined to participate in the Leapfrog survey, Hurley Medical Center participates and receives quality and safety reports from multiple reputable organizations on a continuous basis including Blue Cross Blue Shield, Michigan Health & Hospital Association, Centers for Medicare & Medicaid Services, The Joint Commission and the American College of Surgeons to name a few," Jasso added.
2. UPMC Chautaqua
"Quality and safety for our patients is the foundation of our mission at UPMC Chautauqua," said Brian Durniok, interim president at UPMC Chautauqua in Jamestown, New York. "We continuously strive to enhance our care by adopting best practices. For example, over the past year, UPMC Chautauqua has reduced falls by 18%, reduced seven day readmissions by 37%, and has had zero colon surgical site infections in the past 12 months."
"Our recent integration into UPMC has given us access to some of the best clinical systems and practices in the world and will only help us better care for our patients," Durniok added. "Historically, UPMC Chautauqua has not been an active participant in the Leapfrog survey, and, as such, Leapfrog has relied on secondary sources for data acquisition, which lowers our score. Given the importance of our quality efforts, we will be providing Leapfrog with our data in the future."
3. St. John's Episcopal Hospital
"Since we started reporting in 2016, our grade moved from an F to a D for Spring 2017, Fall 2017, and Spring 2018," said Renee Hastick-Motes, vice president of external affairs for St. John's Episcopal Hospitalin Far Rockaway, New York. "When the methodology changed and new criteria was added to the calculation, in addition to the algorithm pulling data from 2015, our grade shifted back. We look forward to a better grade in the fall. Our patients' safety is always our first priority, to ensure that, we have invested in various new systems and developed new processes."
On Leapfrog's Fall 2018 list, 17 hospitals that earned "F" grades. Two of the nine failing hospitals on this latest list, including St John's Episcopal, received an "F" last fall.
CMS approved waiver extensions, where states submitted changes to their applications that included disenrollment and other penalties, without first hearing public comment.
The approval process for Medicaid waiver amendments lacks transparency and allows states to propose significant changes to their Medicaid Section 1115 applications without detailing the potential effects on enrollees, a new federal review shows.
"CMS does not require amendment applications to include how the changes may affect beneficiary enrollment or report on concerns raised in state public comments," the Government Office of Accountability report released to the public on Friday stated.
"However, states have proposed major changes—such as work and community engagement requirements—through amendments, raising concerns that major changes to states' demonstrations are being approved without a complete understanding of their impact," GAO said.
Forty-three states operate part of their Medicaid program under a 1115 waiver, which amounted to $108 billion in federal spending in 2016, almost one-third of Medicaid's total expenditures. From January 2017 through May 2018, CMS approved applications for a new demonstration, extension, amendment, or a combination of these in 23 states, GAO said.
Demonstrations typically last about five-years but some states have operated parts of the Medicaid programs under demonstration status for decades, GAO said.
GAO examined in detail proposed changes to waiver applications from Kentucky and Indiana that had "substantial potential effects for some beneficiaries," including new eligibility and work requirements, and found inconsistencies in what CMS required from the two states.
"CMS did not require either state to solicit public input, though both states opted to hold a public comment period on the proposed changes concurrent with CMS's review," GAO said.
"Further, CMS reviewed Indiana's proposed changes against limited transparency requirements but did not do so for Kentucky. Indiana submitted a final version of its application summarizing public input and the state's response, while Kentucky did not."
The Affordable Care Act requires CMS to establish transparency guidelines for Section 1115 demonstrations and extensions, but the law did not address amendments, which are subject to transparency guidelines put down by the Department of Health and Human Services in 1994, GAO said.
To improve transparency, GAO recommended that CMS develop policies to ensure transparency when states propose major changes to pending demonstration applications, and when they propose amendments to existing demonstration projects.
The hospital made public a CMS on-site inspection that detailed unsanitary and dangerously inadequate disinfection efforts with patient rooms, and medical equipment.
Five months after a scathing report detailing substandard care and unsanitary conditions prompted the ouster of top executives at Baylor St. Luke's Medical Center, the new leadership at the beleaguered Houston hospital has provided an update on its corrective action plan.
"I promised to take all steps necessary to put the hospital back on the path to excellence and to earn the trust of our patients, their families and our community," St. Luke's President Doug Lawson said in an open letter posted Friday on the hospital's Website.
"In this short time, we have accomplished much – but clearly have much more to do," said Lawson, who took over in February.
"New hospital leadership began stepping into place in mid-January, and we immediately began to address a range of improvement areas across the hospital. We then participated in a full-scale review of every aspect of our operations by experts from the Centers for Medicare & Medicaid Services," Lawson said.
Lawson made public the findings of the 203-page CMS report, which details medication errors, bungled surgeries, unsanitary conditions in the hospital kitchens, dangerously inadequate disinfection of patients' rooms, and medical equipment that posed "immediate jeopardy" to patients that were observed by auditors inside the hospital in late March.
"The results point to remaining housekeeping, maintenance, and patient safety issues that in no way meet our standards, expectations or commitments to our community," Lawson said. "We are taking seriously every opportunity for improvement and we are addressing the findings with urgency. We are confident that the next review will reflect our commitments and accomplishments."
In his letter, Lawson said the alarming conditions detailed by CMS inspectors "did not occur overnight, nor were they the result of any single factor."
"CMS reviewers found deficiencies in the areas of hospital governance, infection control, and food services," Lawson said, adding that the hospital did not contest the CMS findings.
"We take the issues CMS identified seriously and we owe it our patients and their families to correct them immediately – and we have already started to do so through our internal quality program," he said.
The hospital this week filed acorrection plan with CMS and Lawson pledged to "continue to work with our leaders, physicians and CMS to achieve full regulatory compliance."
"We are committed to adhering to safe practices and operations – it is foundational to our organization," he said.
The plaintiff claims that an employee at the hospital gave the person who assaulted her personal information about her, and that the assailtant assaulted her again after she was discharged.
A sexual assault victim has filed a lawsuit against the hospital that treated her.
The Missouri plaintiff claims that an x-ray technician at Atchison Hospital in Atchison, Kansas passed along confidential information about her to the person who allegedly sexually assaulted her in May 2017, resulting in ongoing harassment and a second sexual assault six months after the woman was discharged, according to a complaint filed in U.S. District Court in Topeka, Kansas.
The suit further alleges that managers and medical staff at the hospital soon became aware of the confidentiality breach, but that "no meaningful corrective action was taken."
The alleged assailant was not identified in the suit, and no details were provided on the status of any criminal investigation against that person.
The suit is seeking undisclosed punitive and compensatory damages from the hospital for invasion of privacy, negligence, and breach of fiduciary duty.
According to the suit, the victim identified her attacker to hospital staff while they were administering a rape kit on May 26, 2017, and that the victim adamantly told staff that her Health Insurance Portability and Accountability Act-protected information could not be shared with anyone outside the immediate care team.
However, the information collected from the victim was stored on an unsecured electronic health record, where it later was allegedly improperly accessed by an x-ray technician, who allegedly passed the information on to the alleged perpetrator of the sexual assault.
The information included "facts relating to plaintiff's private life that were not at that time known in the community, contained in a public record, or otherwise available to the public," the complaint said.
"After obtaining plaintiff's confidential and private health information … plaintiff's assailant relentlessly harassed plaintiff through text messages, social media, and phone calls," the complaint said. "Such communications were highly threatening and contained graphic language and pornographic content. The assailant also stalked Plaintiff in public and at her home."
The x-ray technician also allegedly sent text messages to the plaintiff and worked "in coordination" with the assailant by "repeatedly hounding and harassing plaintiff by phone and text," the complaint said.
On Nov. 2, 2017, the x-ray technician was fired for disclosing the information, following a complaint by the plaintiff and an internal investigation by the hospital. However, the suit alleges that Atchison Hospital gave the technician "a positive reference," which allowed her to get a new job at a nearby hospital.
In a letter to the plaintiff, attached to the complaint, Atchison Hospital CEO John Jacobson, apologized, said the hospital had launched an internal investigation as soon as it learned of the breach, and fired the technician shortly thereafter.
"Once we learned of this incident and your concerns, the hospital took immediate action," Jacobson said in the Nov. 2, 2017 letter, adding that the hospital had taken steps to ensure such breaches would not occur again.
On Nov. 4, 2017, the plaintiff said she was sexually assaulted a second time by the same assailant, the complaint said.
Atchison Hospital Responds
In an email to HealthLeaders, Atchison Hospital Marketing Director T.C. Roberts offered the following statement.
"Patient confidentiality at Atchison Hospital and our ability to protect personal information is a top priority of ours. While we are limited with what we can share related to this situation, we are deeply disturbed by the actions of this former employee. In fact, when we were made aware of this situation, we took immediate steps to investigate and within two days, we terminated this individual’s employment.
In addition, we reviewed this specific situation to understand what could be done differently in the future and as a result, immediately implemented changes to our internal controls, including even stricter accessibility requirements to our Health Information Management (HMI) department. We are committed to doing everything possible to provide a safe and caring environment for our patients, and paramount to that is confidentiality and privacy around personal medical information."
Feds spell out how 'spread pricing' is calculated in medical loss ratios.
The Centers for Medicare & Medicaid Services on Wednesday issued new guidelines for medical loss ratios for Medicaid and CHIP managed care plans.
Under existing regulations, MLR regulations for those managed care plans mandate that they exclude prescription drug rebates from the actual claims costs used to calculate an MLR. Federal law requires plans to report MLRs of 85%, with only 15% of the money used for overhead and profits.
The new guidance spells out that "prescription drug rebates" means "any price concession or discount received by the managed care plan or by its PBM, regardless of who pays for it," CMS said. Money kept by PBMs under spread pricing is excluded from the claims costs used to calculate a managed care plan's MLR.
CMS Administrator Seema Verma said the new guidance comes as states raise concerns that Medicaid managed care plans aren’t accurately reporting their pharmacy benefits spread when they calculate MLRs.
"The market for prescription drugs is convoluted and opaque," Verma said in a media release.
"States are increasingly reporting instances of spread pricing in Medicaid, including cases in Ohio and Texas, and I am concerned that spread pricing is inflating prescription drug costs that are borne by beneficiaries and by taxpayers," she said.
The new guidance comes as PBMs find themselves in the crosshairs of the White House. President Donald Trump last year pledged to attack soaring drug costs as part of a broader effort to curb U.S. healthcare spending.
Under spread pricing, PBMs keep some of the money paid to them by health plans for prescription drugs instead of passing the full payments on to pharmacies. That creates a spread between the money the health plans pay the PBMs, and the money the PBMs pay pharmacies for beneficiaries' prescriptions.
Middlemen PBMs can charge plans more than what they paid the pharmacy, which the Trump Administration says raises Medicaid costs for taxpayers.
States have also complained that PBMs can pay pharmacies for generic prescriptions based on lower benchmarks than the benchmarks used for charging Medicaid and CHIP managed care plans for the same drugs.
Verma said the guidance issued Wednesday will ensure that health plans monitor spread pricing appropriately.
"PBMs cannot use spread pricing to upcharge health plans and increase costs for states – spread pricing must be monitored and accounted for, and not used to inflate profits," she said.
CMS said the guidance does not conflict with a recent proposed rule from the Department of Health and Human Services' Office of the Inspector General dealing with safe harbor provisions for prescription drug rebates.
That's because the guidance issued Wednesday would apply only to "items of additional value that must be deducted from the amount of claims cost used for calculating an MLR," CMS said.
Xellia becomes Civica's first supplier partner and will produce antibiotics in short supply in U.S. hospitals.
Civica Rx and Xellia Pharmaceuticals have signed a supply agreement under which Xellia will make antibiotics for Civica's member health systems, the two companies announced Wednesday.
The supply agreement, which includes the antibiotics Vancomycin and Daptomycin, marks the first time that non-profit Civica has launched the production of generic drugs – and the initial medications to be supplied – since the company was established in mid-2018 to address chronic drug shortages.
Civica has committed to partnering with suppliers to deliver 14 essential generic medications this year.
To meet the demand, Xellia, headquartered in Copenhagen, Denmark, will expand its manufacturing and sales within the United States. Xellia produces its own pharmaceutical ingredients, and finished injectable drugs for bacterial and fungal infections.
"We thank Xellia for helping to lead the way in efforts to reduce chronic generic drug shortages in the U.S., including treatments for serious infections caused by bacteria that are resistant to other antibiotics," Martin VanTrieste, president and CEO of Lehi, Utah-based Civica, said in amedia release.
"By helping to stabilize the supply of Vancomycin and Daptomycin, we will have a direct impact on patient safety and public health by providing consistent access to antibiotics that are important treatment options in the management of difficult-to-treat and life-threatening infections," VanTrieste said.
Xellia will make drugs for Civica under Xellia's Abbreviated New Drug Application and Civica labeling and New Drug Code.
"We are honored to work with Civica, an innovator in addressing generic drug shortages," said Carl-Aake Carlsson, CEO Xellia Pharmaceuticals. “Our collaboration also supports Xellia's long-term ambition of mitigating anti-infective drug shortages across the U.S."
The demand for physicians is so frantic that 64% of the 391 residents who answered the survey said recruiters were harassing them.
By John Commins, May 14, 2019
Nearly half (45%) of physicians in their final year of residency received more than 100 recruiting offers, and two-thirds of them (66%) received more than 50 offers, a new survey shows.
"Physicians coming out of training are being recruited like blue chip athletes," Travis Singleton, executive vice president of Irving, Texas-based physicians recruiters Merritt Hawkins, said in a media release. "There are simply not enough new doctors to go around."
The search for physicians has gotten so frantic that 64% of the 391 residents who answered the survey complained that recruiters were virtually harassing them. Seven percent of residents said they were not contacted enough.
The search is rigorous for both primary care and specialty physicians.
Nearly 70% of both primary care and internal medicine subspecialist residents said they received more than 50 recruiting solicitations, as did 64% of surgical specialists.
Singleton says the physician shortage goes beyond the demand for primary care doctors and extends to virtually all subspecialties, too.
"We need more primary care physicians to implement emerging healthcare delivery models that are based on enhanced access, prevention and quality," Singleton said. "But we also need more specialists to care for America’s rapidly aging population."
The Association of American Medical Colleges projects a shortage of nearly 122,000 physicians by 2032, including up to 55,000 primary care physicians and nearly 66,000 too few specialists.
Singleton blamed the physician shortage partly on Congress's 1997 cap on spending for physician training.
RURAL AREAS SEE LITTLE INTEREST
The survey results are bad news for rural hospitals and providers, which have always been hobbled in their efforts to recruit physicians.
For towns of 10,000 people or fewer, only 1% of medical residents expressed an interest in establishing a practice there, while 2% of residents expressed a desire to practice in towns with 25,000 people or fewer.
The majority of new physicians—65%—said they prefer to practice in cities with 250,000 or more people. International medical graduates appeared to be more amenable to practicing in rural areas than U.S. medical school graduates.
The employed-physician model is also gaining ground. More than 90% of new physicians said they would rather be employed than on their own in an independent practice. Of those seeking employment, 43% said they'd prefer to work with a hospital. Two percent said they want to work as a solo practitioner.
"The days of new doctors hanging out a shingle in an independent solo practice are over," Singleton said. "Most new doctors prefer to be employed rather than deal with the financial uncertainty and time demands of private practice."
DEBT BURDENS MOUNT
Fortunately for these new physicians, there are plenty of job offers, because they're knee-deep it debt.
More than half (51%) of final-year medical residents said they owe $150,000 or more in student loans, and 48% say they owe more than $200,000. Only 25% of international medical graduates owe that much.
Only 22% of U.S. medical school graduates said they'd accumulated no debts for their education, while 58% of international medical school graduates said they have no student debt.
Regrets
Even with a plethora of job options, 19% of new doctors say they're unhappy about their choice of profession and would not choose medicine as a career if they could do it all over again.
More than one-in-five (21%) U.S. medical graduates regretted their career choice, compared with 13% of IMGs.
"With high levels of physician burnout and continued uncertainty about the direction of the healthcare system, many doctors are under duress today," Singleton said. "It is not surprising that some newly trained doctors regret their choice of a career."
The decline in screenings is believed to be the result of the cumulative burden of screening discussions earlier in the day, and doctors falling behind in their busy schedules.
Cancer screening rates drop significantly as the physician work day goes on, according to a new study published today in JAMA Network Open.
Researchers in the Perelman School of Medicine and the Wharton School both of the University of Pennsylvania say these rates of decline may be in part due to "decision fatigue," the result of the cumulative burden of screening discussions earlier in the day, and doctors falling behind in their busy schedules.
"Our findings suggest that future interventions targeting improvements in cancer screening might focus on time of day as an important factor in influencing behaviors," Esther Hsiang, the study lead author, a Wharton Business School student, and a researcher with Penn Medicine Nudge Unit, saidin remarks accompanying the study.
The study looked at data from 2014 through 2016 across 33 Pennsylvania and New Jersey primary care practices.
The researchers found that, among eligible patients, primary care doctors ordered breast cancer screening more often for patients seen in the 8 a.m. hour (64%) as compared to those with appointments at 5 p.m. (48%).
Similarly, for colon cancer screening, tests were also ordered more frequently for 8 a.m. patients (37%) compared to those coming in later in the day (23%).
Ordering rates had far-reaching effects. When looking at the entire population eligible for screenings at these practices (roughly 19,000 for breast cancer and 33,000 for colorectal cancer), the study tracked whether the patients were screened within a year of their appointment.
The data showed that the downward trend associated with the timing of the appointments carried over.
Breast cancer screening—including mammograms—stood at a 33% one-year completion rate for the entire eligible population who had their appointment in the 8 a.m. hour. But for those who had clinic visits at 5 p.m. or later, just 18% completed screenings.
For colorectal cancer, screenings such as colonoscopies, sigmoidoscopies, and fecal occult blood tests were completed by 28% of the patients with appointments in the 8 a.m. hour. That number dropped to 18% for patients who saw the doctor at 5 p.m. or later.
The study also found that there was a brief spike in screening orders for breast and colon cancers when patients saw their clinician around noon. For example, breast cancer screening orders dropped to 48.7% at 11 a.m. but increased to 56.2% around noon, before gradually falling off again. This trend held true for one-year completion rates, as well.
The study authors suggest that this may be due to lunch breaks that give clinicians and opportunity to catch up and start fresh.
A downward trend in outcomes by hour was noted in a study in 2018 examining the rates of flu vaccinations by the time of day when patients saw a clinician.
“Our new study adds to the growing evidence that time of day and decision fatigue impacts patient care,” said Mitesh Patel, MD, MBA, director of the Penn Medicine Nudge Unit and an assistant professor of Medicine.
"In past work, we've found that nudges in the electronic health record can be used to address these types of gaps in care, which we suspect will be the case here," Patel said. "Future research could evaluate how nudges may be implemented in order to improve cancer screening."
The 2015 data breach exposed the personal information of 78.8 million people. Anthem says no fraud was ever linked to the breach.
A federal grand jury has indicted a Chinese national for his kingpin role in a sophisticated China-based hacking group that targeted large businesses in the United States, including Anthem Inc.
The four-count indictment, unsealed and handed up Thursday in Indianapolis, alleges that Fujie Wang, 32, and his accomplices breached the computer systems of "four distinct industry sectors," including Anthem and three other U.S. businesses that federal prosecutors did not identify, the Department of Justice said.
The breaches exposed the personal information of 78.8 million people, and Anthem was forced to pay a $16 million fine to settle what DOJ called the largest health data breach in U.S. history.
"The allegations in the indictment unsealed today outline the activities of a brazen China-based computer hacking group that committed one of the worst data breaches in history," Assistant U.S. Attorney General Brian A. Benczkowski said in a media release.
The indictment alleges that beginning in February 2014, the defendants used sophisticated techniques to hack into the computer networks of the victim businesses.
Once inside, the hackers allegedly installed malware and tools on the compromised computer systems to further compromise the computer networks of the victim businesses, after which they identified data of interest on the compromised computers, including confidential personal and business information.
The indictment further alleges that the defendants then collected files and other information from the compromised computers and then stole this data.
The defendants identified and ultimately stole Anthem data on 78.8 million people from Anthem's computer network, including names, health identification numbers, dates of birth, Social Security numbers, addresses, telephone numbers, email addresses, employment information and income data, the indictment said.
Wang and a defendant identified as "John Doe" are charged with one count of conspiracy to commit fraud and related activity in relation to computers and identity theft, one count of conspiracy to commit wire fraud, and two substantive counts of intentional damage to a protected computer.
According to a Wanted by the FBI poster, Wang remains at large, and is believed to be living in Shenzhen, China.
How they did it, allegedly
The indictment said the defendants used extremely sophisticated techniques to hack into the computer networks of the victim businesses.
"These techniques included the sending of specially-tailored 'spearfishing' emails with embedded hyperlinks to employees of the victim businesses," DOJ said. "After a user accessed the hyperlink, a file was downloaded which, when executed, deployed malware that would compromise the user's computer system by installing a tool known as a backdoor that would provide remote access to that computer system through a server controlled by the defendants."
According to the indictment, the defendants waited months before taking further action, eventually engaging in reconnaissance by searching the network for data of interest.
The indictment alleges that the defendants broke into Anthem to reconnoiter Anthem's data warehouse on multiple occasions in October and November 2014.
Once interesting data had been identified, the hackers allegedly placed it into encrypted archive files and sent it through multiple computers to destinations in China. Several times in January 2015, the hackers accessed Anthem's database, and transferred encrypted files containing personal information to China.
To avoid detection, the hackers then deleted the encrypted archive files from the computer networks of the victim businesses.
Anthem Says No Fraud Detected
FBI Special Agent in Charge Grant Mendenhall said "Anthem's cooperation and openness in working with the FBI on the investigation of this sophisticated cyber-attack was imperative in allowing for the identification of these individuals."
In turn, Anthem issued a statement saying it was "grateful for the support and partnership of the FBI and extended law enforcement team in investigating the sophisticated cyber-attack that Anthem was a victim of in February 2015, and are pleased with the action taken today."
"There is no evidence that information obtained through the 2015 cyber-attack targeting Anthem has resulted in fraud," Anthem said.
Wheeling Hospital accuses a former executive of attempting to 'extort a settlement' and filing a False Claims Act suit as an act of revenge.
A West Virginia hospital has flipped the script and is countersuing a former-employee-turned-whistleblower who filed a false claims lawsuit against the hospital.
Wheeling Hospital Inc. has filed a lawsuit against Louis Longo, an accountant, former executive vice president at the health system, and a partner with Deloitte, claiming abuse of process and breach of fiduciary duty.
The hospital alleges that "at no time during his employment, or in his role as a partner at Deloitte, did Longo report any suspicions of fraud or violations of federal regulations to Wheeling Hospital's compliance officer."
"Longo owed Wheeling Hospital a fiduciary duty to refrain from threatening to bring false claims in an effort to extort a settlement," the hospital's suit reads.
Longo's whistleblower suit was taken up in March by the U.S. Department of Justice, which alleges that nonprofit Wheeling Hospital violated the Stark Law and Anti-Kickback Statute.
Those violations allegedly were caused by R & V Associates Ltd., Wheeling's contracted management consultant, and Wheeling CEO Ronald Violi, who the DOJ alleges had "dictatorial control" of the compensation agreements.
Wheeling Hospital has contested the allegations and vowed to fight the suit.
In its countersuit, filed in U.S. District Court for the Norther District of West Virginia, Wheeling Hospital described Longo as a bitter former executive looking to "extort a settlement" based on unwarranted claims that the health system paid kickbacks to physicians for referrals.
"The purpose of Longo's FCA Complaint is for Longo to obtain a pecuniary award and to inflict harm on Wheeling Hospital," the complaint read. "Indeed, based upon information and belief, Longo's FCA Complaint has been characterized by Longo and/or his associates as 'Lou's Revenge.'"
The hospital alleges that Longo approached Violi one month after Longo collected his last paycheck "and threatened that, according to his 'legal team,' he had some kind of case against Wheeling Hospital that could cost the hospital a lot of money unless Wheeling Hospital settled with him."
Wheeling Hospital said Longo's FCA complaint "falsely alleges that during Longo's employment at Wheeling Hospital, Wheeling Hospital 'defrauded...Medicare and Medicaid out of tens of millions of dollars of federal funds by paying certain physicians excessive compensation."
"The allegations in the Complaint are false and were made purposefully by Longo in an effort to receive a quick monetary settlement as a Relator," the suit alleges.
"In fact, in his capacity as a Relator, Longo failed to disclose key evidence to the government including, but not necessarily limited to, the results of a 2015 exempt organization audit conducted by the IRS in which physician compensation for the exact physicians named in his Complaint were reviewed."
Wheeling Hospital is seeking a judgement in excess of $75,000, along with punitive damages, attorneys' fees, court costs.
