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2 ex-Tenet units admit Medicaid fraud scheme

northfulton

North Fulton Hospital, in Georgia.

Two  former  Tenet Healthcare Corp.’s subsidiaries admitted to conspiring to defraud Medicaid by using referral contracts for translation services to funnel pregnant patients to the hospitals. Tenet agreed to pay a $514 settlement to end the case, which again reminded people that  for-profit hospitals tend to have more cases of such corruption because of pressure from senior executives to boost revenue and profit — and stock price.

Atlanta Medical Center and North Fulton Hospital in Georgia each pleaded guilty to one count of conspiracy to violate federal anti-kickback laws and defraud the United States, Tenet said.

In 2014, the U.S. Justice Department joined a whistleblower lawsuit accusing Tenet and four of its hospitals of allegedly making illegal payments to clinics run by Clinica de la Mama and Hispanic Medical Management in exchange for Medicaid patient referrals. Such referrals violate the federal anti-kickback statute and Stark law.

Modern Healthcare reported that the federal government alleged  that Tenet made payments to Hispanic Medical Management under the ruse of commissioning translation, marketing and Medicaid-eligibility determination services.

“The federal government acknowledged that individuals at the hospitals withheld information from Tenet about the agreements and circumvented Tenet’s policies and procedures to prevent such illegal conduct,” the publication reported.

To read the Modern Healthcare article, please hit this link.

Nutmeg State’s small-hospital nightmare

Hartford Courant columnist Kevin Rennie writes well about the difficulties of Connecticut’s community hospitals. Residents are used to living close to these institutions and not that far from a couple of  major regional ones, too, especially Yale New Haven and Hartford Hospital.

But the little  hospitals are under much stress from, as he notes, longevity, industry consolidations, advances in medical technology and dramatic changes in payments for services.

And the trend of “inadequate Medicaid and Medicare reimbursements will continue. Almost every time the hospitals make cost reductions to meet lower reimbursement rates, the rates get lower again.”

Thus Waterbury Hospital, St. Mary’s Hospital, in Waterbury, Bristol Hospital, Manchester Memorial Hospital and Rockville General Hospital, all nonprofits, are imperiled.

Meanwhile, political, ideological and regulatory pressures have repelled such out-of-state for-profit hospital chains as Tenet that could save some or all of these little hospitals if they’d buy them.

 Something gotta give!

 

 

 


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