UnitedHealthcare Accuses Emergency Care Provider TeamHealth Of Fraud

Modern Healthcare: UnitedHealthcare Sues TeamHealth, Alleges Fraud
UnitedHealthcare is suing emergency care provider TeamHealth, alleging the company deliberately and systematically tricked the health insurer into paying more than $100 million in fraudulent claims. The lawsuit, filed in the U.S. District Court for the Eastern District of Tennessee on Wednesday, accuses private-equity-owned TeamHealth of violating state and federal laws governing fraud, insurance regulation and consumer protection by upcoding hundreds of thousands of emergency department bills. (Tepper, 10/27)

In other corporate news —

Columbus Ledger-Enquirer: St. Francis-Emory Hospital In Columbus GA Getting New Owner
The owner of St. Francis-Emory Healthcare is merging with a hospital chain to create a new healthcare company by the end of 2021. LifePoint Health, owner of the hospital, and Kindred Healthcare announced plans Tuesday to establish ScionHealth, a new national health system that will launch at the close of LifePoint’s acquisition of Kindred. (Mixon, 10/27)

Louisville Courier Journal: Kosair Charities Gives $6.4M To UofL Children's Spinal Injury Program
On Tuesday, Kosair Charities, an organization focused on children's health, announced a $5.5 million grant for U of L's Kosair Charities Center for Pediatric NeuroRecovery, founded in 2014 to help children regain movement and mobility after a spinal cord injury. The award was among four totaling $6.4 million Kosair Charities announced for programs to identify and prevent child abuse, treat pediatric cancer and monitor infants in U of L Hospital's neonatal intensive care unit. (Yetter, 10/27)

Philadelphia Inquirer: Tower Health Records Massive Loss On St. Chris And Other Hospitals It Bought In Philadelphia Region
Tower Health has officially recognized what has long been obvious: The hospitals, urgent care centers, and other businesses that it bought for at least $480 million from 2017 to 2019 are not worth nearly what the system paid. That’s why the Berks County nonprofit, anchored by Reading Hospital, in West Reading, recorded a $370.7 million loss on those businesses in its audited financial statements for the fiscal year ended June. 30, which were released Wednesday. (Brubaker, 10/27)

Modern Healthcare: Former HHS Official Eric Hargan To Advise Digital Health Startup Amino 
Eric Hargan, former deputy secretary of the Department of Health and Human Services, will advise Amino, a digital health platform that helps workers at self-insured employers find and book appointments with providers, the company announced Wednesday. Hargan will help Amino navigate surprise billing and price transparency regulations under the auspices of his new consulting firm, The Hargan Group. Amino plans to update its platform to comply with the new rules. (Brady, 10/27)

Also —

The Boston Globe: Boston Medical Center Surgeon Fined For Leaving Operating Room To Eat In His Car, Then Falling Asleep And Missing The Procedure
The longtime head of spine surgery at Boston Medical Center has been reprimanded by state regulators and fined $5,000 for leaving an operating room before the start of an emergency ankle surgery to go eat in his parked car, where he fell asleep and missed the procedure. Dr. Tony Tannoury, 54, admitted that he woke up in his car that November night in 2016, called the teaching hospital, and was told that a chief resident had performed the operation he was supposed to oversee, according to a consent order released Monday by the Massachusetts Board of Registration in Medicine. Tannoury didn’t return to the hospital until the following day. (Saltzman, 10/27)

Axios: The Next Pandemic Will Need New Communication Strategies 
"Be first, be right, be credible" is the mantra of public health experts in a crisis. It's difficult to argue that the health community has regularly managed to be any of those three during COVID-19. A pandemic isn't just a medical emergency — it's also a communications emergency. The U.S. public health establishment, hamstrung by bad data and political interference, has struggled with the latter. It may be too late to repair the bad messaging that has marred the COVID-19 response, but better communication strategies will be needed for the inevitable next pandemic. (Walsh, 10/28)

KHN: Medicare Punishes 2,499 Hospitals For High Readmissions 
The federal government’s effort to penalize hospitals for excessive patient readmissions is ending its first decade with Medicare cutting payments to nearly half the nation’s hospitals. In its 10th annual round of penalties, Medicare is reducing its payments to 2,499 hospitals, or 47% of all facilities. The average penalty is a 0.64% reduction in payment for each Medicare patient stay from the start of this month through September 2022. The fines can be heavy, averaging $217,000 for a hospital in 2018, according to Congress’ Medicare Payment Advisory Commission, or MedPAC. Medicare estimates the penalties over the next fiscal year will save the government $521 million. Thirty-nine hospitals received the maximum 3% reduction, and 547 hospitals had so few returning patients that they escaped any penalty. (Rau, 10/28)

KHN: Look Up Your Hospital: Is It Being Penalized By Medicare?
Under programs set up by the Affordable Care Act, the federal government cuts payments to hospitals that have high rates of readmissions and those with the highest numbers of infections and patient injuries. For the readmission penalties, Medicare cuts as much as 3 percent for each patient, although the average is generally much lower. The patient safety penalties cost hospitals 1 percent of Medicare payments over the federal fiscal year, which runs from October through September. Maryland hospitals are exempted from penalties because that state has a separate payment arrangement with Medicare. Below are look-up tools for each type of penalty. You can search by hospital name or location, look at all hospitals in a particular state and sort penalties by year. (Rau, 10/27)