SDCMC Physician Assistant Pleads Guilty to Healthcare Fraud

Cal Graves, who worked as a physician assistant at South Dallas Community Medical Center, pleaded guilty earlier this week to conspiracy to commit healthcare fraud. He faces a maximum sentence of five years in prison, a $250,000 fine, and restitution. Graves and physician Daniel Leong, who owned SDCMC, were charged in September 2011 with seven counts of healthcare fraud and conspiracy to commit healthcare fraud for their roles in a Medicare and Medicaid scheme involving prescription drugs and diagnostic testing. The offenses took place at a SDCMC clinic on Martin Luther King Boulevard in Dallas. According to Federal Bureau of… Full Story

As Solo Physician Practices Dwindle, Economic Impact is Felt

The burden of healthcare delivery reforms and declining reimbursements quietly are driving solo physician practitioners to close up shop, merge, or become employees of hospitals or government agencies. A little-recognized impact of that trend is the lost economic benefit of a physician office. According to a  2011 Lewin Group analysis, the 11,700 Dallas-Fort Worth office-based physicians accounted for nearly $18 billion in economic output, about 70,000 jobs, and more than $11.5 billion in wages and benefits in 2009. Additionally, Texas office-based physicians generate 95 cents in indirect economic output for every dollar the practice generates. Examples include purchases of office… Full Story

Annual Healthcare Cost for Dallas Families Tops $20,000

According to the 2012 Milliman Medical Index, the annual household cost of healthcare for a typical Dallas family has cracked the $20,000 mark. The Seattle-based actuarial and consulting firm annually calculates the total cost of care for a family of four enrolled in an employee-sponsored PPO plan. The $20,435 annual cost in Dallas was just below the U.S. estimate of $20,728. The national figure includes $12,144 in employer-cover insurance costs and $8,584 paid by the family—including $5,155 in insurance premiums paid by the employee whose family is covered by the plan, and $3,470 in out-of-pocket expenses. Dallas costs rose 7.1… Full Story

Emcare: The Largest Medical Group in Texas

The largest medical group in Texas is a company few have heard of outside the hospital sector. Emcare, a national leader in physician outsourcing services, is the nation’s largest emergency department (ED) contractor, according to Modern Healthcare. The nation’s 10th largest medical group has 158 offices nationally and nearly 800 physicians, according to SK&A. The company’s first client was Baylor, which was seeking to outsource its ED physician staffing in 1972. Three decades later, Emcare provides services to more than 500 hospitals in 40 states and treats more than nine million patients annually. Its ED services include management, recruiting, billing… Full Story

Groups Merge to form “Physician-led Integrated Health System”

Irving-based USMD is merging with Urology Associates of North Texas (UANT) and Medical Clinic of North Texas (MCNT) to form what it calls a “physician-led integrated health system.” The move unites more than 240 physicians and associate practitioners, 18 specialties, and 64 clinics in Dallas-Fort Worth. The larger corporate entity, USMD Holdings, owns or operates hospitals, cancer treatment centers, and kidney stone treatment service providers with more than 400 physicians in 10 states. USMD has hospitals in Fort Worth and Arlington governed by physician-led boards of directors. All three organizations were originally formed in the 1990s. Dr. John House, managing… Full Story

Thriving in the New Healthcare Environment

There were two big takeaways from the Health Industry Council’s 2012 Southwest Healthcare Transactions Conference in Dallas. First, regardless of whatever shape the health-reform law takes, its impact on delivery transformation will endure. The law has prompted physicians and hospitals—which historically have coexisted warily—to join forces to satisfy payers who are demanding greater value instead of volume. Accountable care organizations and patient-centered medical homes are rapidly forming to create higher-quality, lower-cost and better-coordinated patient care. Second, keynote speaker Paul Kusserow of Humana made it clear Dallas-Fort Worth has arrived as a center of healthcare innovation. He listed the North Texas… Full Story

Emergency Medicine Under Pressure

Emergency departments are frequently stereotyped as a hospital’s “money-loser.” Due to the concentration of resources needed to staff an ED, they are expensive to operate and increasingly becoming overcrowded. The Supreme Court’s June 28 ruling pushes forward The Patient Protection and Affordable Care Act, which will extend insurance coverage to millions of uninsured Americans. Healthcare reform is likely to exacerbate the burden on EDs as health insurance does not guarantee access to care. More than 20 million additional people are expected to receive Medicaid, and it is likely that a substantial number of them will visit the ED because of… Full Story

NFIB v. Sebelius: More About Law Than Healthcare

As a healthcare lawyer, many friends and acquaintances have asked my opinion on the Patient Protection and Affordable Care Act Supreme Court case. Fortunately, the decision gave me a really easy answer to that question. Although it certainly didn’t break the way I thought it would—or, for that matter, hoped it would—it did vindicate what I have said all along about Obamacare and healthcare reform generally: The Affordable Care Act is much more focused on health insurance reform or health finance reform than it is on healthcare reform. And the Supreme Court case isn’t about healthcare at all; it’s all about… Full Story