DOJ Recovers Over $2.8 Billion in False Claims Act Cases in 2018

On December 21, 2018, the U.S. Department of Justice (DOJ) announced their recovery of more than $2.8 billion in settlements and judgments from civil cases involving fraud and false claims for fiscal year (FY) 2018. While 2018 marks the ninth consecutive year in which healthcare fraud settlements exceeded $2 billion, this year’s amount was the lowest recovery since 2009. Approximately $2.5 billion was recouped from the healthcare industry for federal losses alone, and included recoveries from drug and medical device companies, managed care providers, hospitals, pharmacies, hospice organizations, laboratories, and physicians. This figure, over 87% of the total recovery amount, far outstripped the $107.5 million recovered from defense contractor companies and the $259.6 million obtained from other industries such as banking. (Read more...)

Hospitalist Pilot Model Sparks Controversy

A pilot program in two Naples Community Hospital (NCH) Healthcare System hospitals, where only NCH-employed hospitalists handle admissions and direct in-patient care (i.e., “The Hospitalist Model”), has sparked controversy within the Naples, Florida community. The Hospitalist Model aims to foster a collaborative approach to in-patient healthcare through a hospitalist and support team in order to enhance patient-centered care and in-patient outcomes, congruent with the system’s stated commitment to quality. However, patients and independent physicians have expressed significant concern regarding the potential disruption of the doctor-patient relationship that may occur upon the expansion of this model when a hospitalist controls in-patient care, rather than the patient’s established primary physician. (Read more...)

National Healthcare Spending Slows for Second Straight Year

A recent analysis conducted by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) has found that, although healthcare spending rose to $3.5 trillion in 2017, the U.S. national health expenditure (NHE) growth rate slowed, declining from 4.8% in 2016 to 3.9% in 2017. Of note, this is the second consecutive year that healthcare spending has slowed, reaching its lowest increase in growth since 2013. This growth has been somewhat slower than the growth rate of the overall economy, which was 4.2% in 2017; however, healthcare spending was still a large percentage of the U.S. gross domestic product (GDP), at 17.9%.This Health Capital Topics article will review this CMS analysis, as well as the various healthcare spending components examined by the agency. (Read more...)

Valuation of Dialysis Centers: Regulatory

Healthcare organizations, including dialysis centers, face a range of federal and state legal and regulatory constraints, which affect their formation, operation, procedural coding and billing, and transactions. With existing federal and state regulations related to medical liability, licensure, accreditation, certificate of need, fraud and abuse, and antitrust laws, the expansive regulatory landscape of the U.S. healthcare industry greatly shapes the practice of medicine and the delivery of healthcare services. This fourth installment in the five-part series regarding dialysis centers will review the regulatory environment in which these enterprises operate. (Read more...)

ANNOUNCING

Advanced Distance Education to Launch in 2019

The Institute for Healthcare Valuation (IHV) & Consultants' Training Institute (CTI) are pleased to announce premier healthcare valuation training through a distance education program, the Certificate of Educational Achievement (CEA) for Advanced Education in Healthcare Valuation. The program will launch in 2019 and will bridge the interdisciplinary nature of healthcare valuation to include: the Four Pillars of Healthcare (regulatory, reimbursement, competition, and technology); the market forces shaping the U.S. healthcare industry; and the valuation of healthcare enterprises, assets, and services. Legal professionals and healthcare providers, as well as those wishing to expand their scope of activities in healthcare valuation engagements and those seeking to enhance their current healthcare valuation service lines, will gain comprehensive knowledge through completing the expansive program. The program has been developed and is being presented by industry thought leader Health Capital Consultants , alongside a blockbuster faculty of healthcare subject matter experts from the legal, federal regulatory, and valuation professions.

HCC President, Todd Zigrang , and Vice President and General Counsel, Jessica Bailey-Wheaton , were recently interviewed by the National Association of Certified Valuators and Analysts (NACVA) , where they discussed the development of the distance education program along with the topics that will be covered. Click HERE to watch the entire interview.