Methodist Le Bonheur Healthcare (MLH), a non-profit healthcare system consisting of five hospitals as well as outpatient and ancillary services, has been accused of paying kickbacks in exchange for patient referrals. Between 2012 and 2018, over $400 million was allegedly paid by MLH for referrals from physicians at The West Clinic, a Memphis, Tennessee based, for-profit private physician group of medical oncologists, gynecologic oncologists, radiologists, and other physician specialists. The relators, a former MLH executive leadership team member and the former CEO for Methodist University Hospital, claim that MLH induced the referrals of cancer patients to their facility through kickback payments made to The West Clinic, in violation of numerous fraud and abuse laws. (Read more...)

On September 18, 2020, the Centers for Medicare & Medicaid Services (CMS) announced the publication of its final rule on specialty care models, which included a new End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model. The ETC Model was created in response to a July 10, 2019, executive order that launched the “Advancing American Kidney Health” initiative. This model amends regulations originally set forth in the National Organ Transplant Act of 1984. The initiative generally seeks to achieve three goals: “fewer patients developing kidney failure, fewer Americans receiving dialysis in dialysis centers, and more kidneys available for transplant.” (Read more...)

On September 14, 2020 the Centers for Medicare & Medicaid Services (CMS) released the financial and quality performance results for the Medicare Shared Savings Program (MSSP) Performance Year (PY) 2019. The results revealed record net savings of $1.19 billion for Medicare, marking the third consecutive year of net savings. Most significantly, included in these results are the first six months of performance for accountable care organizations (ACOs) that enrolled in the MSSP under one of the Pathways to Success models that commenced in July 2019. These results provided the first look at ACO performance under the new, controversial model. (Read more...) 

The second installment in this five-part Health Capital Topics series on the valuation of telemedicine will focus on the reimbursement environment for telemedicine. Telemedicine is reimbursed based on the services provided through this medium and includes many restrictions on where, how, and by whom services can be conducted. The first installment in this series introduced telemedicine and its increasing importance to, and popularity among, providers and patients. It also discussed the current and future challenges related to telemedicine, many of which hinge upon reimbursement restrictions and regulations. (Read more...) 

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On November 17, 2020, HCC President, Todd A. Zigrang, MBA, MHA, FACHE, CVA, ASA, and, HCC Vice President and General Counsel, Jessica Bailey-Wheaton, Esq., will present on the topic of "Regulatory Overview for Valuation Professionals," during the National Association of Certified Valuators and Analysts (NACVA) 2020 Financial Valuation Virtual Conference.

Details and registration for the conference forthcoming HERE.