The Number of Uninsured Children Growing in Texas – Why Hospitals Should Care

Between December 2017 and April 2019, the number of Texas children enrolled in Medicaid and CHIP dropped by more than 201,700, or about 6%. That’s according to the Center for Public Policy Priorities presentation at the State of Reform Conference in Irving last month. The trend is part of a larger trend of fewer Texas children having health insurance. Fewer children and adults on Medicaid increases the likelihood that patients will avoid care until absolutely necessary, and much more expensive, which has an impact on uncompensated care provided by hospitals in the state. The drop has coincided with increased anti-immigrant rhetoric… Full Story

Methodist’s ACO is a Top Five Medicare Savings Organization

Methodist Health System’s Patient-Centered Accountable Care Organization saved $84 million since 2012, placing it in the top five in the country for ACOs, according to The Centers for Medicare and Medicaid Services. ACOs have grown in popularity as insurance payers are looking for ways to reduce costs, pushing some of the risk onto the providers in order to incentivize efficiency and reduce unnecessary care. ACO deals are structured so that the provider can share in the savings to Medicare. In 2018, Methodist’s ACO saved more per beneficiary than any other in ACO, at $13 million. It is the first ACO in… Full Story

Watch a North Texas Opioid Pill Mill in Action

In a report from WFAA, viewers can watch as an undercover agent posing as a truck driver obtains opioids from a pill-mill doctor in North Texas. In May, Dr. Tad Taylor and another North Texas physician were sentenced to federal prison for illegally distributing opioids and other controlled substances. The video of the DEA investigation shows a conversation between Taylor of Taylor Texas Medicine and Nick Bristow, who was then a DeSoto police officer. Bristow and Taylor speak briefly, and Taylor says that he needs to put something in the chart about an injury in case he gets audited. On a… Full Story

Flower Mound Doctor Named in “One of the Largest Health Care Fraud Schemes Ever”

Federal authorities have charged 35 individuals in a fraudulent genetic testing operation that resulted in $2.1 billion in losses, including a Flower Mound physician. The defendants are associated with numerous telemedicine companies and cancer genetic testing laboratories that fraudulently billed Medicare. Dr. Daniel R. Canchola of Flower Mound Texas was charged for referring Medicare patients for unnecessary “cancer screening” tests, and received kickbacks and bribes for the orders. Canchola allegedly made the orders without seeing or having a relationship with patients, and beneficiaries often never received their testing results. He is allegedly responsible for $69 million in fraudulent claims to… Full Story

Ruling Saves Trees and Halts Methodist Dallas Wellness Center – For Now

The pecan grove on the Methodist Dallas campus has been saved for now, The Dallas Morning News reports. East Kessler resident Katherine Homan has won a court decision that invalidates the City Council’s decision earlier this year that paved the way for the hospital to build a new fitness center ad take down 11 large pecan trees. A bitter feud erupted over the construction of a state-of-the-art fitness center that would disrupt the preservation of 11 pecan trees and the beloved green area surrounding the Methodist Dallas Medical Center.  State District Judge Bonnie Goldstein’s Monday ruling has put a halt… Full Story

How Three North Texas Docs Allegedly Defrauded the Federal Government

Three local physicians are caught up in the 58-person health care fraud indictment across the state of Texas for their relationships with marketing companies and compounding pharmacies. The charges say the doctors received kickbacks for writing prescriptions for patients covered by the Department of Defense health care program even though the doctors never saw the patients. Dallas has been a frequent target for health fraud investigations, and the region is coming off another kickback/marketing scheme in the Forest Park trial this winter. Dallas is one of the more expensive cities in the country to receive healthcare, and is a hotbed… Full Story

Texas Has Third-Highest Insurance Rebates For Individual Market

Private insurers will pay a record of around $1.3 billion in rebates to consumers this year for excessive premiums relative to health care expenses, surpassing the record high of $1.1 billion in 2012, according to a Kaiser Family Foundation report. Rebates may either be paid out in the form of a premium credit or as a lump sum, though lump sum is more common. Rebates are the result of insurance companies not meeting the Affordable Care Act’s medical loss ratio threshold, which requires insurers to spend at least 80 percent of premium revenues (85% for large group plans) on health… Full Story

Massachusetts Nurses Settle Unfair Labor Charges Against Steward Hospital

Over 100 registered nurses at a Massachusetts hospital have settled their dispute with Dallas-based Steward Health Care and received wage increases, access to a defined pension and other improvements, the Lowell Sun reports. The nurses had previously filed unfair labor practice charges with the U.S. National Labor Relations Board after the for profit healthcare company issued a threat to close the hospital unless nurses stopped negotiating. Several Massachusetts politicians had spoken in favor of the nurses, the Sun reports. “It’s a great victory for the nurses who stood up for themselves and others in the community,”David Schildmeier, public communications director for… Full Story

Federal Charges for 58 Texans in $66 Million Healthcare Fraud and Opioid Takedown

A coordinated effort across the state by the Justice Department has resulted in charges against 58 people across the state for health care fraud and “pill mill” networks resulting in $66 million in losses and 6.2 million pills. Amongst the charged are 16 doctors or medical professionals, and 20 who were charged for diverting opioids. Billing schemes for unnecessary prescription drugs focused on Medicare, Medicaid, TRICARE, Department of Labor-Office of Worker’s Compensation Programs, and private insurance companies were targeted in the investigation. The drugs were often never purchased or given to those for whom they were intended. The charges are… Full Story

Blue Cross-Knox City Conflict May Be Going to Federal Court

Blue Cross Blue Shield of Texas is hoping to move the legal battle with Knox County Hospital District to federal court, and the temporary restraining order hearing scheduled for September 10 has been suspended. After 50th District Court Judge Bobby Burnett issued the TRO ordering BCBS to pay Knox County Hospital more than $21 million in what they allege are unpaid insurance claims, BCBS filed a motion in U.S. District Court for Northern Texas in Wichita Falls to move the case to federal court because BCBS of Texas is owned by Health Care Services Corporation in Chicago. “Blue Cross Blue… Full Story