The HHS Office of Inspector General (OIG) released its annual report on healthcare fraud and abuse last week. According to the report, 71 hospitals and health systems paid $163.4 million to settle healthcare fraud allegations in FY 2013. Some of the more notable results included: Winning or negotiating more than $2.6 billion in healthcare […]
Last week we reported on a new report that found no conclusive relationship between hospital consolidation and price increases in a community. There is a new wrinkle, however. A hospital or system merger with a large physician group practice may not pass the competition/price increase test. In Idaho last month, a district judge sided with […]
The Center for Healthcare Economics and Policy released a report in late January that found no conclusive relationship between hospital consolidation and hospital price increases in communities in the U.S. HFMA wrote that the study “challenges conventional wisdom about the impact of consolidation on hospital prices.” (“Study: Relationship Between Hospital Mergers, Price Increases Often Overstated,” […]
Compliance and risk management efforts of hospitals and health systems should focus on indications from the Department of Health & Human Services (HHS) Office of the Inspector General (OIG) about the direction it intends to take to investigate fraud, waste and abuse. We have talked with OIG investigators over the years who have been straightforward […]
Typically, when a credit rating organization releases projections for the upcoming year, the analysis includes a mix of both positive and negative factors. For 2014, however, Moody’s Investors Service analysts hold no punches; they list the negative factors that led them to a categorical negative outlook, and appear to be hard pressed to find any […]
In addition to the difficulties people continue to experience when trying to purchase health insurance via the federal exchange/marketplace, hospitals also can expect to weather some difficulties as more people become insured through the federal/state exchanges. The health insurance exchanges resulted from a provision of the Affordable Care Act. It was anticipated that each […]
This week’s newsletter comes a few days earlier than usual because we want our subscribers to have a full picture of the impact of the government shutdown on public health. Thanks to the American Health Lawyers Association, we can present a summary. The shutdown began on October 1, resulting from the Senate’s vote to […]
The pace of consolidations will likely increase over the next several years, and an attractive consolidation model has surfaced—virtual mergers—according to the authors of a new Special Comment by Moody’s Investors Service. Moody’s comment focuses on two broad types of virtual merger structures; in each, debt is separately secured by each partner: Parent-subsidiary model: […]
Hospitals and health systems appear to be stronger and healthier today than three years ago, according to a recent Moody’s Investors Service report, and better prepared to withstand the changes in reimbursement under the Affordable Care Act (ACA). “Though total debt outstanding has increased since the recession, there has been a notable improvement in […]
“Excessive market concentration” may be one of the best-known causes of high healthcare costs, reported the New York Times last week (“Health Care’s Overlooked Cost Factor,” New York Times, June 11, 2013). Hospital consolidations have contributed to highly concentrated hospital markets, and consolidations continue today. The article notes there have been more than 1,000 hospital […]