Baylor Scott and White Health has escaped an lawsuit alleging they upcoded claims after a Texas judge dismissed a False Claims lawsuit, according to Law360. The whistleblower lawsuit claims BSW was responsible for more than $61.8 million in fraudulent claims to medicare over seven years. Filed in 2017, the claim says BSW’s medical director led the effort to increase higher billing codes without medical justification. U.S. District Judge David Ezra said the claimant failed to provide a claim a relief, saying there is nothing wrong with hospitals taking advantage of coding opportunities to increase Medicare payment that is supported by documentation.… Full Story
The U.S. Department of Health and Human Services announced earlier this month that the Parkland Center for Clinical Innovation will be contributing its capabilities to support the “Advancing American Kidney Health Initiative.” Nearly 100,000 Americans are waiting on the list to receive a kidney transplant, with kidney disease ranking as the ninth leading cause of death in America, costing Medicare $114 billion a year. PCCI is focused on improving healthcare for vulnerable populations by using advance data science and clinical experts and will now advance efforts to learn more about kidney health. With 37 million patients suffering from chronic kidney… Full Story
After the FBI raided the Medoc Health Services offices last year, the federal government is pursuing a lawsuit against the Dallas-based pharmacy services provider for false claims and kickbacks. The claim alleges that Medoc received around $2 million from North Texas pharmacies for sending prescriptions their way through affiliated physicians. Shawn Shinneman wrote about the original scandal after he was contacted by employees ready to describe the impropriety. You can read the most recent update over on D Magazine’s site. Check it out here.
McKesson Corp. has been named in a Cleveland lawsuit against many of the largest players in the pharmaceutical industry, the Washington Post reports. The filing describes the drug companies as solely focused on profits at the cost of the damage done to country by opioids. The companies say they should not be charged with second guessing the expertise of doctors who prescribe the pills. The case consolidates claims from around the country, and because of documents released by a three judge panel last week, the direction and quantity of drugs is better able to be tracked between manufacturers, distributors, and… Full Story
Aida Somun, the Chief Operations Officers at Parkland Center for Clinical Innovation was named to the Board of Examiners for the 2019 Malcolm Baldridge National Quality Award by the Commerce Department’s National Institute of Standards and Technology (NIST). The Baldridge Award is the nation’s highest honor for organizational innovation as well as excellence in overall performance. Somun has 15 years of experience as a business leader focused on profitable growth and saving costs. She consistently contributes to bottom line efficiency, performance, and process improvements and is passionate about strategic decision-making to create the right innovative programs that will improve the … Full Story
The 86th Texas Legislative Session came to an end without any movement on physicians’ ability to expense a limited number of common prescription drugs, so two Texas doctors are taking their case to the Travis County Civil District Court, where they are claiming the ban on physician dispensing is unconstitutional. Texas is out of step with the rest of the nation when it comes to the rule, as it is just one of five states to ban physicians from dispensing anything but free samples to their patients, though the state does allow doctors to dispense medications if they live more than… Full Story
Last week, President Trump signed an executive order meant to improve price transparency in healthcare. As the market moves toward increased transparency, local healthcare companies are trying to figure out how it will impact their business, and some are very well-positioned to embrace the move toward a purer market. “Opaque pricing structures may benefit powerful special interest groups, such as large hospital systems and insurance companies, but they generally leave patients and taxpayers worse off than would a more transparent system,” the order reads. In January, a federal law went into place forcing hospitals to post their prices, though these… Full Story
Vizient and the Parkland Center for Clinical Innovation have been chosen by the Centers for Medicare & Medicaid Services as a Prime awardee of the Network of Quality Improvement and Innovation Contractor for their ability to improve healthcare quality. The designation means PCCI and Vizient can bid on CMS Task Orders over the next five years. The two organizations will serve as innovative quality improvement experts and agents for healthcare transformation. They may provide technical assistance in a variety of segments of the industry, obtain commitments from various stakeholders, team up with patients and families about improved outcomes, and assist providers in obtaining… Full Story
Holmes Murphy announced 12 new employee shareholders this week, two of which are in Dallas, continuing as a privately-held independent insurance brokerage. Shareholders lead the company and help determine the direction of initiatives, establishing culture, and recruiting talent. The two new Dallas shareholders are: Claire Pancerz, Compliance Consultant, Employee Benefits Shawn Quildon, AVP – Client Service Director, Employee Benefits Holmes Murphy is an 87-year-old insurance brokerage that serves businesses via property casualty insurance, employee benefits, captive insurance, risk management and loss control.
In the most recent legislative session, Texas lawmakers passed three bills addressing surprise medical billing, freestanding emergency room price-gouging, and prescription drug price transparency. The bills are a win in the fight for patient and consumer protection against unforeseen medical billing, an issue that Texas lawmakers have been seeking to put an end to for years. Perhaps the biggest success of the three is the passing of SB 1264, which prohibits heath care providers from sending surprise bills to patients when the patient had no true choice of providers as when a patient seeks care from an in-network hospital but… Full Story