Blue Cross Blue Shield, UT Southwestern, Texas Health Resources Team Up to Provide Care in North Texas

Blue Cross Blue Shield of Texas and Southwestern Health Resources are coming together to form an Accountable Care Organization that will coordinate services to serve Blue Cross’ more than 130,000 members in North Texas, according to Pharmiweb. The agreement provides access to Southwestern Health Resources Accountable Care Network, which was established as a partnership between Texas Health Resources and UT Southwestern Medical Center that includes doctors, caregivers, hospitals and other facilities throughout the region. An Accountable Care Organization is a group of healthcare providers who voluntarily join to coordinate care to medicare patients. They hope to avoid duplication and errors… Full Story

The Impact of Healthcare Navigator Funding Cuts in Texas

The state of Texas has 4.8 million adults who don’t have health insurance, or about 17.3 percent of the population. That ranks the state dead last in the country in insured adults, according to Community Services. As a part of the Affordable Healthcare Act, the Centers for Medicare and Medicaid Services awards grants to organizations called navigators, who help uninsured Americans work through the healthcare exchanges in each state. But since 2013, the funds for those navigators have decreased by more than 80 percent in Texas, which also voted not to expand medicare. In 2013, CMS awarded more than $10… Full Story

This Study Describes How M&A’s Will Impact the Future of Healthcare

A paper presented at the Texas Health Law Conference this week outlines how mergers and acquisitions and disruptive innovation are creating healthcare world increasingly focused on patients. The Polsinelli law firm’s paper analyzes several mergers and acquisitions in the healthcare industry and makes conclusions about the future of the healthcare industry, and was written by Dallas office lawyers Jon Henderson, Andrew Kinworthy, and Kevin McDonnell. Several themes arose in the study, including private equity ownership, integrated care continuum, consumerism, shifting from in-patient to out-patient care and toward value-based care centered around data analytics. The paper concludes that these changes will improve patient care… Full Story

Grand Prairie Hospital in Danger of Losing Medicaid and Medicare Funding

Centers for Medicaid and Medicare Services put Texas General Hospital in Grand Prairie on notice after finding that the facility endangered patients by not providing some services and allowed staff to provide care they are not qualified to give, according to Modern Healthcare. Federal and state auditors made surprise visits to the hospital earlier this year, finding several deficiencies that could result in losing federal reimbursement from CMS. “The (hospital’s) governing body failed to provide a safe setting for patients in that there is no adequate staff to care for the patients, and no supplies and medications needed to provide safe… Full Story

Guilty Plea in Fraud Case From Forest Park Surgeon and Founder

Dr. Wade Neal Barker admitted to being part of a $200 million fraud, bribery and kick back scheme in federal court on Friday, the The Texas Lawbook reports. The bariatric surgeon helped found the since-closed Forest Park Medical Center. Barker is the seventh of the 21 indicted officials associated with the chain of luxury hospitals to admit guilt, according to the The Texas Lawbook. Barker is accused of handing out $40 million in bribes to cooperating doctors. As a founder with access to sources and documents, Barker’s plea may pay dividends for the prosecution. He could end up with a sentence of… Full Story

Texas Health Aetna Hopes to Reduce Drug Costs Through Data and Education

Texas Health Aetna’s new campaign hopes to educate physicians on inexpensive versions of drugs to reduce healthcare costs across the board. Called Go-to Green, the health insurance provider is using data to find cheaper prescription options. Texas Health Aetna’s Chief Medical Officer Dr. Delanor Doyle says that the company utilizes data from Texas Health Resources and Aetna to find out what drugs are being prescribed by which physicians and to whom in their netowrk. If they are aware of a medicine that is equally effective and cheaper, they will contact the physicians and let them know about the more inexpensive… Full Story

Next Health Owners Plead Guilty to Money Laundering and Kickbacks

Two men plead guilty in a medical kickback case in Dallas where doctors steered patients to certain hospitals and were paid for it, according to the Dallas Morning News. The owners of the Next Health network of pharmacies, Andrew Hillman, 42, and Semyon Narosov, 54, gave people $50 gift cards to urinate in cups at Whataburger bathrooms. The urine was sent for superfluous testing at Next Health labs acting as a wellness study, according to the DMN. The allegations came to light from a 2017 lawsuit in which United Healthcare sued Next Health for $100 million. Hillman and Narosov admitted that Next… Full Story

An Amputee And The Cost Of A Medevac

Doctors amputated Dr. Naveed Khan’s arm after injuries from an ATV crash along the Red River near Wichita Falls, Texas, and his case is a microcosm of the tension between insurance and air ambulance companies. Khan is a 35-year-old radiologist who was enjoying an ATV ride with his friend when he tipped the vehicle and gashed his arm, according to KERA. They rushed to the United Regional Health Care System in Wichita Falls, but he needed to be treated at a trauma center as quickly as possible. The severity of the injury required the medevac ride, according to Dr. Rajesh Gandhi,… Full Story

ACAP Picks A President Of Its SimplePay Division

ACAP Health has named Scott Schoenvogel to lead its SimplePay Health division. Schoenvogel comes over from Compass PHS, a company he founded and helped build to more than 2,200 clients and 1.5 million members. Compass was acquired by Alight Solutions in June, as I reported here. ACAP, which went through a rebrand last year, calls SimplePay a “new model for healthcare insurance plans designed to make health care simple for employees while reducing costs for employers.” “Scott brings a high level of experience and knowledge in the healthcare industry,” said ACAP Health CEO Wally Gomaa in a statement. “Scott is… Full Story

Texas Patient’s $109K Hospital Bill Cut To $332

Thursday, I pointed you to a story about an Austin patient who had a very unexpected heart attack, spent four days at a hospital for surgery and treatment, and was later balance billed for about $109,000. Friday, Kaiser Health News chimed in with an update:  The bill has been reduced by St. David Medical Center to $332—and officially paid off. Drew Calver, 44, and his family get to put the episode behind them. Here’s the story with the update, and the original is right here.