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.

Texas Patient Hit With A $109,000 Bill Following Out-of-Network Treatment For Heart Attack

Kaiser Health Network put up a story this week that has made some noise. It’s on 44-year-old Drew Calver, a high school history teacher in Austin who, despite appearing to be in great health, suffered a heart attack last April. He was taken to St. David’s Medical Center, a hospital under HCA Healthcare-run St. David’s Healthcare, where he had emergency surgery and spent the greater part of the next four days in the cardiac unit. St. David’s is out of network for Calver’s school-issued plan. After the insurer covered about $56,000 for the treatment and stay, Calver was hit with… Full Story

MedPAC Recommendations Could Impact North Texas’ Dozens of Stand-alone ERs

In June, when the Medicare Payment Advisory Commission issued a two-pronged recommendation regarding stand-alone emergency departments, it pointed to one metropolitan area to illustrate growth in independent freestanding ERs: Dallas. From 2013 to 2017, the Dallas metro went from having 25 such facilities to 73. The entire U.S. has just 200. The recommendation issued by MedPAC calls for changes in the way Medicare bills stand-alone ERs and, to be clear, has nothing to do with independent freestanding ERs, which are not associated with a hospital and which the federal government doesn’t recognize. It has everything to do with stand-alone ERs… Full Story

Texas Tribune Runs Through Factors On States’ Side in Fight To Dismantle ACA

All arguments have been submitted in the case that pits Texas and 19 other states against the Affordable Care Act, according to the Texas Tribune. That means a federal judge, right here in North Texas, now holds the key to the healthcare law’s future. Experts say a ruling should come in the next few months, according to the Trib, which ran through several factors in Texas’ favor in a story this week: It’s not the first time Texas has sued over Obamacare, but this attempt has several weighty advantages. One comes from Congress, which in December shrunk the penalty for… Full Story