Justice Department Alleges Kaiser Permanente Coerced Medicare Claim Upcoding
Modern Healthcare reports on a new complaint from the Justice Department that alleges Kaiser Permanente coerced employees to upcode claims for Medicare Advantage beneficiaries. Northside Hospital, Cigna, Encompass, Betsy DeVos at the Theranos trial and more are also in the news.
Modern Healthcare:
5 Things About DOJ's Upcoding Allegations Against Kaiser
Kaiser Permanente allegedly coerced employees to upcode claims for Medicare Advantage beneficiaries, resulting in an estimated 75% error rate, according to a new complaint from the U.S. Justice Department. The federal government intervened in six related lawsuits in July and filed a complaint Monday, outlining how Kaiser physicians allegedly changed medical records often months after care was provided to boost the Oakland, California-based integrated health system's Medicare Advantage reimbursement. More than half of Kaiser physicians said they were forced to add diagnoses they did not consider, evaluate or treat, according to one of the whistleblowers and former Kaiser medical coder, Randi Osinek. (Kacik, 10/26)
In other health care industry news —
Gwinnett Daily Post:
Northside Hospital Wins Appeal To Open Outpatient Surgical Center In Braselton
A state appeals panel has given Northside Hospital its blessing to build an outpatient surgery center in Braselton. The Georgia Certificate of Need Appeal Panel decision is being hailed by the hospital system — which has hospital campuses in Lawrenceville and Duluth — as a win for patients in northeast Georgia. The Department of Community Health denied Northside’s Certificate of Need request to build the center in 2018 and the hospital system had been appealing the decision since then. (Yeomans, 10/25)
Modern Healthcare:
Cigna Leans On MDLive For New Virtual-First Plan
Cigna launched a virtual-first plan for select employers on Tuesday, with its new offering following the recent announcements of other major insurers and coming just in time for open enrollment. Like UnitedHealth Group, Aetna and Centene, Cigna's new virtual-first plan offers a $0 copay, and will start in January 2022. Cigna will offer virtual-first primary, dermatology, behavioral and urgent care services for employers, and digital dermatology to its exchange members. Although the new virtual-first plan will only be available for certain employers, all business customers will have access to MDLive's network of more than 2,500 virtual clinicians for wellness and behavioral health checks, prescription refills and emergency care. (Tepper, 10/26)
Dallas Morning News:
Lawsuit Accuses High-Profile Health Care CEO April Anthony Of Stealing People, Ideas From Encompass
April Anthony, founder of leading home health care company Encompass, is being accused of breaching her employment contract by secretly meeting with employees after leaving the firm earlier this year, resulting in five high-ranking executives joining her new competing venture. Dallas-based Encompass Health, founded by Anthony in 1998, and Birmingham-based Encompass Health Corp., which trades on the NYSE and acquired Encompass Health in 2014, sued Anthony Tuesday in state court in Dallas. The lawsuit accuses Anthony, 54, of Highland Park, of violating an employment agreement she signed in October 2019 that prohibited her, once she left Encompass, from recruiting away employees for two years or engaging in a competing business for a year. (Walters, 10/26)
KHN:
How Billing Turns A Routine Birth Into A High-Cost Emergency
Caitlin Wells Salerno knew that some mammals — like the golden-mantled ground squirrels she studies in the Rocky Mountains — invest an insane amount of resources in their young. That didn’t prepare her for the resources the conservation biologist would owe after the birth of her second son. Wells Salerno went into labor on the eve of her due date, in the early weeks of coronavirus lockdowns in April 2020. She and her husband, Jon Salerno, were instructed to go through the emergency room doors at Poudre Valley Hospital in Fort Collins, Colorado, because it was the only entrance open. (Bichell, 10/27)
In updates on the Theranos trial —
CNBC:
Theranos Investor Betsy DeVos' Rep Says Elizabeth Holmes Misled Them
A representative for Betsy DeVos’s family office told jurors in the Elizabeth Holmes criminal trial that the former Theranos CEO provided misleading financials and details about the company’s technology in soliciting an investment. DeVos, the former education secretary in the Trump administration, invested $100 million in Theranos in 2014. Lisa Peterson, who oversees private equity investments at RDV Corp. and handled the Theranos deal, testified on behalf of the family on Tuesday. (Khorram, 10/26)
