The suit alleges that CHS stonewalled an independent IT audit, which would show that the for-profit hospital chain was giving hospitals it had sold unlicensed access to software.
The troubles continue for Community Health Systems Inc.
Microsoft Corp. filed suit against the Franklin, Tennessee-based for-profit hospital chain this week, claiming that CHS has been "willfully infringing" on Microsoft's copyrights with extensive, unlicensed use of its software.
In the suit, Redmond, Washington-based Microsoft said it began investigating CHS' possible violations of its volume licensing agreement in 2016, when CHS began an extended string of hospital divestitures.
Since then, Microsoft said, its contractual right to an independent audit of the use of its software has been hobbled by CHS.
Under the contract, if an audit reveals 5% or more of CHS' use is unlicensed, the hospital chain has to reimburse Microsoft for the cost of the audit, and buy the licenses at 125% of the price for each product.
"CHS has been largely not responsive to, if not obstructionist of, Microsoft's contractual right to an independent verification," the Redmond, Washington-based software giant said in court documents.
Microsoft claims it has given CHS "every opportunity to comply with the independent verification process, and Microsoft has exhausted its best efforts to resolve this matter without judicial intervention."
"CHS' pattern of conduct, including missing numerous mutually agreed upon deadlines and providing incomplete data, demonstrates its unwillingness to comply with its contractual obligation and/or with the independent verification process," the complaint read.
In October 2016, Deloitte & Touche LLP was retained to audit CHS' usage of Microsoft software. Thus began a 16-month-long series of stonewalling tactics that included oft delayed or cancelled meetings, "ostensible technical issues," incomplete data submissions, and repeated missed deadlines, the suit alleges.
At one point, the suit alleges, CHS tried to include a non-disclosure agreement that would limit both the audit and the release of the information to Microsoft.
"Restricting the release of information to Microsoft would defeat the purpose of the independent verification process," the complaint read, "as it would prevent Microsoft from being able to fully verify CHS' licensing and contract compliance."
Finally, after months of badgering by Deloitte, CHS submitted data in December, 2017, that was still incomplete, but which showed that CHS' use of the software was more than 500% larger than what it had disclosed the previous January.
CHS did not return calls seeking comment.
The troubled company has been selling hospitals over the past two years in an effort to reduce a debt burden created with the ill-fated $7.6 billion acquisition of Naples, Florida-based Health Management Associates Inc. in 2013.
The Microsoft suit was filed in U.S. District Court in Murfreesboro, Tennessee. Read the complaint below:
Porter Adventist mailed letters to patients who had orthopedic or spine surgery, warning them of a potential infection risk owing to improperly cleaned surgical instruments.
Porter Adventist Hospital in Denver on Wednesday notified patients who had orthopedic or spine surgery within the past 20 months that they may have been exposed to surgical site infections for hepatitis B, hepatitis C or HIV.
"The process for cleaning surgical instruments following orthopedic and spine surgeries was found to be inadequate, which may have compromised the sterilization of the instruments," said Colorado Department of Public Health & Environment CMO Larry Wolk, MD.
The letters were sent to patients who had orthopedic or spine surgery at Porter between July 21, 2016 and Feb. 20, 2018, warning them of the potential infection risk.
It was not made clear how many people may have been exposed to the potential infections, but Colorado public health officials said they are not aware of any patient infections related to the breach.
Wolk cautioned that the risk of surgical site infection related to the breach is unknown, but that the risk of getting HIV, hepatitis B or hepatitis C because of this issue "is considered very low."
The state health department was notified of the breach Feb. 21. The department conducted an on-site survey of infection control practices at the hospital. A disease control investigation is ongoing.
The department last visited the hospital March 28, confirming that current infection-control practices meet standards.
Porter Adventist stopped using and reprocessed all surgical equipment in question Feb. 20. The hospital said there appears to be no increased risks to current surgery patients.
More Americans are accessing their personal electronic medical records, and find the data helpful and easy to use, but policymakers say half of the nation doesn’t see a need to do so.
The federal government today released a new online guide to help patients and their caregivers access personal electronic health records.
The guide, put out by the Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology, is designed to support the 21st Century Cures Act goal of improving patient access to electronic health information, and the MyHealthEData initiative , HHS said.
"It's important that patients and their caregivers have access to their own health information so they can make decisions about their care and treatments," said Don Rucker, MD, national coordinator for health information technology. "This guide will help answer some of the questions that patients may have when asking for their health information."
ONC said that in 2017, half of Americans reported they were offered access to an online medical record by a provider or insurer. This is up from 42% in 2014. More than half of people who were offered online access viewed their record with the past year. Eight in 10 people who viewed their information rated their online medical records as both easy to understand and useful for monitoring their health.
Despite those improvements, ONC said challenges remain. Almost half of Americans in 2017 who were offered access to an online medical record did not access their record, often citing a perceived lack of need as one of the reasons for not accessing their record.
ONC said the lack of use suggests that consumers are not aware of their HIPAA Privacy Rule right to access their health information, or the benefits that come with that access.
Study suggests that a variety of factors are at play when patients rate physicians, many of which are beyond the immediate control of the physician.
Negative online reviews of physicians on sites such as Healthgrades.com often are at odds with the more positive responses the same physicians get with patient satisfaction surveys, according to a new study this week in Mayo Clinic Proceedings.
Compared with colleagues without negative reviews, however, the physicians score lower on factors that go beyond patient interactions and are beyond their immediate control, the study found.
"Our study highlights the disconnection between industry-vetted patient satisfaction scores and online review comments," said study senior author Sandhya Pruthi, MD., an internal medicine physician at Mayo Clinic.
"Patients need to be aware of these distinctions as they make decisions about their health. Physicians also need to be aware, as they manage their online reputations," Pruthi said.
In a pilot between September and December 2014, researchers used Google searches and alerts to track negative online reviews of physicians at Mayo Clinic’s Rochester campus. Of 2,148 physicians, 113 had negative online reviews. The physicians represented 28 departments and divisions.
Researchers then compared these physicians’ scores in a formal patient satisfaction survey with the scores of other Mayo Clinic physicians in similar fields who had no negative online reviews. Researchers found no statistical differences in the overall scores, or in the scores for patient communication and interaction.
However, the group with negative reviews scored much lower on factors beyond patient-physician interactions, such as interaction with desk staff, nursing, physical environment, appointment access, waiting time, problem resolution, billing and parking.
Pruthi conceded that the study was limited because physician groups were small, as was the time period to collect data. The online reviews reflected single experiences of patients, and the data did not identify the instances or patient experiences that led to negative reviews.
In an editorial accompanying the study, Bradley Leibovich, MD, a urologist at Mayo Clinic, said the findings "underscore the totality and integrity of processes, elements and encounters – and not just the patient-provider interaction – that all need to be effectively and cohesively in place to ensure optimal patient experience and welfare."
The inconsistencies of physician reviews have been pointed out in other studies.
Hospital for Special Surgery researchers found discrepancies between doctor reviews provided by hospital websites and those posted on independent physician rating websites. Investigators found a much higher number of reviews and more favorable physician ratings overall on the hospital websites.
Federal prosecutors say the trio allegedly conspired to force Blue Cross and Blue Shield of Alabama cover diabetes services provided by Trina Health LLC.
An Alabama state legislator, a lobbyist, and a healthcare executive have been charged in a bribery scheme that attempted to coerce Blue Cross Blue Shield of Alabama into covering diabetes services provided by a California-based clinic, the Department of Justice said.
The Alabama defendants are State Rep. Jack D. Williams, 60, and Martin J. "Marty" Connors, 61, the former chairman of the Alabama Republican Party.
The California defendant is G. Ford Gilbert, 70, the owner of Carmichael, California-based Trina Health LLC, which operates diabetes clinics in 10 states and India.
According to the indictment, Trina Health opened three clinics in Alabama in 2014 and 2015, but was told that Blue Cross and Blue Shield of Alabama, the state's largest health insurer, would not cover the treatments.
Prosecutors allege that Gilbert schemed to force Blue Cross to change its position. He pushed a bill through the Alabama Legislature’s 2016 session that would require Blue Cross to cover the treatments and he allegedly bribed Alabama House Majority Leader Micky Hammon to make it happen.
Gilbert also hired Connors to lobby the bill. Conners worked with Hammon to recruit Williams, the chairman of the Alabama House's Commerce and Small Business Committee, to hold a public hearing on the bill.
The federal indictment charges all three defendants with conspiracy to commit bribery related to federal programs, conspiracy to commit honest services wire fraud, and honest services wire fraud.
The indictment also alleges that Gilbert and Connors committed bribery related to federal programs.
Gilbert is charged with wire fraud, healthcare fraud, and interstate travel in aid of racketeering.
The indictment does not include charges against Hammon because he is already in prison, having already been convicted in federal court of other offenses.
If convicted of the most serious offenses, Willams, Connors and Gilbert each faces a maximum sentence of 20 years in prison, fines, asset forfeiture, and restitution, DOJ said.
A strong majority of physicians responding to a one-question survey support work requirements for beneficiaries, despite opposition to the idea from the American Medical Association and other physician associations.
Three-in-four physicians favor a new federal policy that allows states to require Medicaid applicants to first prove they're working or looking for job, a new survey by Merritt Hawkins shows.
The single-question in the Dallas-based physician recruiter’s online survey asked 667 physicians what their position is on the new Medicaid work requirements policy. More than half (56%) said they feel very favorably about the policy, and 18% said they feel somewhat favorably.
Only 9% of physicians said they feel very unfavorably toward the policy and 8.4% said they feel somewhat unfavorably. The remaining 8% said they had no opinion either way.
"The survey strongly suggests that the majority of physicians would like to move away from the Medicaid status quo," said Travis Singleton, executive vice president of Merritt Hawkins.
"Many physicians have been frustrated for years because Medicaid often pays less than their costs of providing care," Singleton said. "Physicians have to limit the number of Medicaid patients they treat for that reason and want to focus on those who need care the most."
Kentucky, Indiana and Arkansas are implementing work requirements in their Medicaid programs. In Kentucky, able-bodied Medicaid applicants 19-64 years old will be required to put in 80 hours of community engagement a month to qualify for Medicaid benefits, which includes working, going to school, training for a job, or volunteering. The policies in Indiana and Arkansas have similar requirements.
"It remains to be seen whether the policy can be carried out fairly and effectively, but in concept, it appears to have the endorsement of most physicians," Singleton said.
The survey was conducted by email in early March and was completed by 667 physicians and has a margin of error of less than 1%, Merritt Hawkins said.
While the survey suggests overwhelming support for work requirements from physicians, elsewhere, the idea has proven to be controversial.
Delegates said the work requirements would increase administrative costs and impose documentation burdens on frail and vulnerable people.
In February, the American College of Physicians urged the Centers for Medicare & Medicaid Services to reject the proposals put forward by the three states.
"Our policy firmly states that being employed or conducting job search activities should not be a condition of eligibility for Medicaid," said ACP President Jack Ende, MD.
"Instead, Medicaid waivers should focus on providing greater access to health services and keeping patients healthy, rather than requiring them to work in order to receive care," he said.
Franklin, Tennessee–based Community Health Systems' efforts to pare down its debts continues with the divestiture of Bayfront Health Dade City acute care hospital. CHS has sold four hospitals so far this year.
Debt-hobbled Community Health Systems has sold its 120-bed Bayfront Health Dade City hospital in Florida and its physician and outpatient services to Adventist Health System, the two hospital chains announced Monday.
Financial terms were not disclosed.
CHS said the Bayfront sale was a planned divestiture that was made public in a fourth-quarter earnings call. For-profit, Franklin, Tennessee–based CHS has sold four other hospitals so far this year in its ongoing efforts to pare down debt.
"Our organization is growing, and we are excited about the opportunity to deliver Christ-centered, wholistic care to those in Dade City and the surrounding areas," said Terry Shaw, president and CEO for Adventist Health System.
On Sunday, Bayfront Health Dade City was renamed Florida Hospital Dade City. It joins Adventist Health System’s West Florida Division, which includes Florida Hospital Carrollwood, Florida Hospital at Connerton Long Term Acute Care, Florida Hospital Heartland Medical Center Lake Placid, Florida Hospital Heartland Medical Center Sebring, Florida Hospital North Pinellas, Florida Hospital Tampa, Florida Hospital Wauchula, Florida Hospital Wesley Chapel and Florida Hospital Zephyrhills.
Adventist named Jason Newmyer as administrator for Florida Hospital Dade City and vice president of nearby Florida Hospital Zephyrhills. Newmyer will oversee strategic development and operations at the hospital.
Florida Hospital Dade City is a primary stroke care center, with 150 physicians representing 27 medical specialties, including bariatrics, cardiology, emergency services, gynecology, neurology, surgery, and urology.
With the Dade City acquisition Adventist Health System now operates 27 hospitals in Florida.
Dade City is located about 40 miles northeast of Tampa.
Total civil recoveries are down $400 million from fiscal year 2016, but in line with the five-year annual average of $1.2 billion.
More than 1,500 people or entities were convicted of Medicaid fraud or abuse and neglect in 2017, and prosecutors collected $1.8 billion in civil and criminal recoveries, federal auditors said in their annual report on the $565 billion program.
In addition, 1,181 care givers or entities were kicked off the program in 2017 as a result of fraudulent or abusive behavior, according to the report, which was published by the Department of Health and Human Service's Office of the Inspector General.
The $1.1 billion in civil recoveries in 2017 is down from the $1.5 billion collected in 2016 but is roughly in line with a five-year average of $1.2 billion. Of the 961 civil settlements and judgements in 2017, 426 (44%) involved pharmaceutical manufacturers, led by the $465 million Mylan settlement.
The 1,528 total convictions for fraud, abuse and neglect in 2017 are roughly the same as in 2015 and 2016. However, the $693 million in criminal recoveries in 2017 were almost double those collected in 2016, largely owing to a single $519 million recovery from a wide-ranging criminal enterprise in Texas.
Of the 1,157 fraud convictions in FY 2017, 523 (45%) involved personal care services attendants and agencies; 36 involved family practice physicians; 88 involved nurses, licensed practical nurses, physician assistants or nurse practitioners; 54 involved home health agencies; and 25 involved mental health facilities.
Of the 371 convictions for patient neglect or abuse, 112 involved nurses’ aides, or certified nursing assistants; 76 involved RNs, LPNs, PAs or NPs; 59 involved personal or home healthcare aides; 32 involved non-direct care staff; and 13 involved assisted living facilities.
The report is based on data collected from the mostly federally funded Medicaid Fraud Control Units, which operate in 49 states and the District of Columbia.
MFCUs recovered $6.52 for every $1 spent. The units operate on a combined $276 million annual budget, $207 million of which is funded by the federal government.
Medicaid represents about 17% of the $3.3 trillion annual national healthcare expenditure, according to HHS.
California prosecutors allege the Sacramento-based health system engages in illegal practices that stifle competition and lead to higher healthcare costs for consumers.
The California Attorney General’s Office has filed suit against Sutter Health, alleging that the largest health system in Northern California is engaged in anticompetitive practices that are raising healthcare costs for consumers.
"Sutter Health is throwing its weight around in the healthcare market, engaging in illegal, anticompetitive pricing that hurts California families," California Attorney General Xavier Becerra said Friday.
"These tactics are risking Californians' lives by driving up the cost of healthcare for everyone. Big business should not be able to throttle competition at the expense of patients," Becerra said.
Sutter Health spokesperson Karen Garner said the Sacramento-based health system was still reviewing the suit and could not comment on the specifics of the complaint.
"It's important to note that publicly available data show that on average, total charges for an inpatient stay in a Sutter hospital are lower than what other Northern California hospitals charge," Garner said.
Establishing, increasing and maintaining Sutter Health's power to control prices and exclude competition;
Foreclosing price competition by Sutter Health's competitors;
Enabling Sutter Health to impose prices for hospital healthcare services and ancillary products that far exceed the prices it would have been able to charge in an unconstrained, competitive market. Those pricing practices went toward more acquisitions, extreme levels of executive compensation, and financing its own insurance arm.
The complaint alleges that Sutter violated the Cartwright Act by:
Preventing insurance companies from negotiating with it on an anything other than “all-or-nothing” system-wide basis. This means that health insurers are required to negotiate with all of Sutter Health system or face termination of their contract;
Preventing insurance companies from giving consumers more low-cost health plan options. For example, an insurance company might charge a $200 out-of-pocket cost for an outpatient surgery performed by a facility outside of the preferred group, and $100 for outpatient surgery performed by a facility inside the preferred group;
Setting excessive high out-of-network rates for patients who must seek care outside of their provider network. These rates exceed those of Sutter’s competitors and Medicare.
Restricting publication of provider cost information in rates.
The AG’s complaint comes in the wake of a new report by University of California Berkeley’s Petris Center on Health Care Markets and Consumer Welfare that documents how the rapid consolidation of healthcare markets in California has led to rising healthcare costs for consumers throughout the state.
The cost of the average inpatient hospital procedure in Northern California $223,278 exceeded that in Southern California $131,586 by more than $90,000, the report found.
Sacramento-based Sutter Health includes 24 acute care hospitals, 31 ambulatory surgery centers, nine cancer centers, six specialty care centers, nine major physician organizations, 8,200 physicians and 48,000 employees in 19 counties in Northern California.
Sutter Health also negotiates contracts on behalf of a variety of other affiliated physician groups, the largest being the Palo Alto Medical Foundation.
Garner's entire statement reads as follows:
"We are aware that a complaint was filed, but we have not seen it at this time, so we cannot comment on specific claims.
Sutter Health is proud to save patients, government payers and health plans hundreds of millions of dollars each year by providing more efficient and integrated care. It's important to note that publicly available data (from the California Office of Statewide Health Planning and Development) show that on average, total charges for an inpatient stay in a Sutter hospital are lower than what other Northern California hospitals charge.
Further, Sutter Health has held average overall rate increases to health plans to the low single digits since 2012 in spite of our actual expenses for labor, facilities and technology increasing more than 37% during the same time period. We don't know why some health plans have increased their rates to consumers as much as 20% annually.
It's also important to note that healthy competition and choice exists across Northern California. There are 15 major hospital systems and 142 hospitals in Northern California, including Kaiser Permanente, Dignity, Adventist, Tenet, UC and more. And health plans can elect to include or exclude parts of the Sutter Health system from their networks, and health plans have been doing so for many years."
Family physicians say payers don't remove the barriers to non-pharmacological alternatives to chronic pain management such as physical therapy and home healthcare.
A clinical guidance panel for the nation’s 36 Blue Cross Blue Shield companies has adopted a professional standard that opioids should not be prescribed as a first or second line of pain therapy in most clinical situations.
The standard was unanimously supported at the March meeting of the Blue Cross Blue Shield Association's National Council of Physicians and Pharmacist Executives, which includes physicians and pharmacists from Blue Cross and Blue Shield companies around the nation.
The standard is in line with guidelines from the Centers Disease Control and Prevention. BCBSA said its companies will promote alternatives that include more non-opioid prescription painkillers and over-the-counter pain medications.
"Due to the lack of evidence combined with significant potential for harm, we believe professional standards require that BCBS members are given alternative options to opioids in most clinical situations," said Trent Haywood, MD, chief medical officer for BCBSA.
"We will work with medical professionals to ensure BCBS members are routinely provided alternatives to opioids through a mutual decision made inside the doctor's office," Haywood said.
The standard adoption comes as the Centers for Disease Control and Prevention this week reports that drug overdoses in the United States are a growing problem for every demographic and region in the nation.
Drug overdoses killed 63,632 Americans in 2016. Nearly two-thirds of these deaths involved a prescription or illicit opioid. Overdose deaths increased in all categories of drugs examined for men and women, people ages 15 and older, all races and ethnicities, and across all levels of urbanization, CDC said.
More than 20% of BCBS commercially insured beneficiaries filled at least one opioid prescription in 2015, according to a BCBSA study. The report also showed beneficiaries with an opioid use disorder diagnosis spiked 493% over a seven-year study period.
Ryan Stanton, MD, an emergency physician in Lexington, KY, and a spokesman for the American College of Emergency Physicians, said the new standard from BCBSA will not have much of an impact in the emergency department.
"They’re jumping on to something we were already moving towards. Hospitals are re-evaluating the way we are addressing opioids," Stanton said.
"What BCBSA is saying, which our programs say a little better, is go with evidence-based medicine, which is what we didn't do with the opioid crisis," he said. "We were pushed in several different directions to give opioids for every pain complaint. What we are realizing now and what the evidence is showing is that they are not the best option in most cases."
Michael L. Munger, MD, a family physician in Overland Park, KS, and president of the American Academy of Family Physicians, said physicians understand that opioid misuse is a serious public health issue, but he bristled at the BCBS guidance.
"A blanket ban on the prescription of pain medication ignores the reality that each patient’s treatment must be individualize to his or her specific situation. Policies must recognize that pain management requires patient-centered, compassionate care as the foundation of treatment," Munger said.
"The AAFP opposes limiting patient access to any physician-prescribed pharmaceutical without cause, as well as any actions that limit physicians' ability to prescribe these products based on the physician’s medical specialty," he said.
Munger said BCBS and other public and private payers are pushing for a ban on drug therapies but do little to encourage non-pharmacologic therapies for chronic pain.
"The administrative burden and required pre-authorizations for prescribing non-pharmacologic therapies, such as physical therapy or home health, dissuades physicians from ordering such treatments," Munger said.
"Equally important, coverage plans require copayments and deductibles that add financial burden and disincentives to patients suffering chronic pain," he said.
Haywood said BCBS companies cover non-opioid pain treatment options, and medication-assisted treatments, and provide training for doctors and pharmacists, customized coaching services for those with chronic pain and support for families in addiction recovery.
"Because Blue Cross and Blue Shield companies represent one in three Americans in diverse communities with diverse needs, we are taking a comprehensive approach to addressing the opioid epidemic through prevention, intervention and treatment," Haywood said.
