Pharmaceutical Gross sales Consultant Admits Well being Care Fraud Conspiracy and Conspiring to Interact in Cash Laundering and Impede Justice | USAO-NJ

CAMDEN, NJ – A pharmaceutical sales rep admitted today that he was conspiring to defraud New Jersey County’s health programs and to engage in money laundering and obstructing justice, US Attorney General Rachael A. Honig said.

Paul Camarda, 39, of Holmdel, New Jersey, pleaded guilty to U.S. District Judge Robert B. Kugler in Camden Federal Court over information alleging a health fraud and obstruction of justice conspiracy and engagement Money laundering.

According to documents filed in this case and statements made in court:

Camarda was a sales representative for a pharmaceutical company. He started a side business called Dynasty Capital LLC to independently commercialize medical products and services for other businesses, including compound prescription drugs for specialty pharmacies. Camarda marketed compound drugs for several pharmacies, including New Jersey and out of state pharmacies, identified in court documents as “Compounding Pharmacy 1”, “Compounding Pharmacy 2”, “Compounding Pharmacy 3” and “Compounding Pharmacy 4”. As part of his agreements with the pharmacies and his conspirators, Camarda received a percentage of the insurance payments he received for prescriptions arranged by him and his staff.

Compound drugs are specialty drugs that are mixed by a pharmacist to meet the specific medical needs of an individual patient. Although compound drugs are not approved by the Food and Drug Administration (FDA), they are properly prescribed when a doctor determines that an FDA-approved drug, such as dye or other ingredient, does not meet a particular patient’s health needs.

Camarda learned that certain local government employees had insurance coverage for these particular compound drugs. A facility identified as a “pharmacist benefits administrator” on court documents provided pharmacy benefits administration services for the Bergen County’s Prescription Benefits Program (BCPBP), which covered certain local government employees, including county jailers. The pharmacy benefits administrator paid prescription drug claims and then billed the BCPBP for the amounts paid.

Camarda was a leader and manager of the conspiracy. He and his conspirators discovered that certain compound drugs – including vitamins and pain, scar, antifungal, migraine, and libido creams – reimbursed up to thousands of dollars for a month’s supply. Camarda recruited individuals with BCPBP coverage to fraudulently obtain medically unnecessary compound drugs. He provided the recruits with blank prescription forms and directed them to see an unnamed doctor – referred to as “Person 1” in court documents – to obtain his approval for the compound prescription drugs. The investigation found that all recruits visit Person 1 to get the prescriptions within days, and all Person 1 received prescriptions authorized by Person 1 for the same specialty drugs on the same day or within days. The recruits agreed to receive the very expensive compound drugs, not because they needed them, but because they were paid for by Camarda. Camarda instructed the recruits that the more compound drugs they were given and the more people they recruited to get the drugs, the more money they could make from the conspiracy.

Camarda received more than $ 2.2 million in payments for the prescriptions he and his staff arranged, and Camarda and his recruits created more than $ 3.4 million in fraudulent claims filed by the pharmacy benefits administrator for compound drugs were presented. Camarda’s payments from the blending pharmacies and his conspirators, as well as Camarda’s payments to his recruits, served as the basis for the money laundering conspiracy charge, which Camarda pleaded guilty to.

In 2017, Camarda learned that federal agents and a federal grand jury were investigating the health fraud conspiracy. Camarda has plotted to obstruct the federal investigation by providing and instructing false information to other federal agents and the grand jury.

The number of healthcare conspiracies Camarda is guilty of has a maximum potential sentence of 10 years in prison and a fine of $ 250,000 or double the gain or loss from the crime, whichever is greater. Obstruction of justice and the money laundering conspiracy count carry a maximum penalty of five years in prison and a fine of $ 250,000 or double the gross profit or loss of the crime, whichever is greater. The conviction is scheduled for November 18, 2021.

Acting US Attorney Rachael A. Honig has credited special agents to the IRS Criminal Investigation, under the direction of Special Agent in Charge Michael Montanez in Newark; Special Agent for the FBI’s Atlantic City Resident Agency under the direction of Special Agent in Charge George M. Crouch Jr. of Newark; and special agents from the US Department of Labor Office of Inspector General, New York Region, under the direction of Special Agent in Charge Michael C. Mikulka, whose investigation resulted in today’s admission of guilt.

The government is represented by US Assistant Attorneys Christina O. Hud and R. David Walk Jr. of the US Attorney’s Office in Camden.

Main Care Workforce Burnout Goes Past EHR Use to Management Type

By Hannah Nelson

June 23, 2021 – A new health issue study found that burnout was not related to EHR satisfaction or the number of patients treated per clinician. Instead, the researchers found that conducive leadership, which focuses on building relationships, improving communication, ensuring psychological safety, and promoting teamwork, is associated with low burnout rates in the workforce.

Facilitative leadership deviates from traditional hierarchical structures and enables practices to promote new leadership skills in all practice members, explained the study authors.

The results are based on a survey of 715 small to medium-sized general practitioners’ practices.

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“Respondents who felt a greater sense of support and workplace control were able to offset known stressors – including high patient numbers – and had lower overall burnout rates,” said Samuel T. Edwards, MD, MPH, assistant professor of medicine at the OHSU School of Medicine and the study’s lead author said in a Press release.

While the survey gathered responses from small to medium-sized primary care facilities, the study authors argued that primary care practices of all sizes could help alleviate clinical stress through supportive guidance.

“Larger practices and health systems can promote leadership and agency by delegating decision-making to the lowest possible level of their organizations, and practices of all configurations could benefit from interprofessional leadership development,” the authors write.

Personal interventions such as counseling or time off from work can help a person suffering from burnout, explained Edwards. However, to impact the general well-being of an entire practice or care team, leaders should consider an organization-wide approach that leverages conducive leadership.

“Creating supportive environments and more local control to balance staff and patient needs could provide better ways to provide the best care to everyone,” suggested Edwards, who is also a personal physician with the Veterans Affairs Portland Health Care System is working.

Most “zero burnout” practices also used quality improvement strategies more frequently than institutions with higher rates of Burnout among the workforce.

“Burnout improvement efforts should consider focusing on whole practices and the systems in which they are embedded,” noted the authors.

In addition, the study found several structural features that affect clinicians’ burnout rates. Solo practices had the lowest burnout rates. In addition, clinicians owned and practices that did not participate in external transformation initiatives such as B. responsible care organizations, a lower burnout status. This suggests that the ability to act can be linked to organizational and professional well-being.

“Smaller practical agreements with fewer employees can lead to better communication, stronger practical relationships and more ability to act, which together could contribute to less burnout,” stated the study authors.

“Although there has been a trend towards consolidation, smaller independent practices remain an important part of primary care in the US, with small practice models such as direct primary care emerging,” the report’s authors write.

To support small physician-owned practices at a time of industry consolidation, the authors called for funding for primary care practice expansion networks that provide external technical support to the practice.

Although this study did not identify the ease of use of the EHR as a major challenge for primary care practices, the practice might adapt to it EHR usage.

According to a recent one study, many primary care practices have EHR usability barriers.

April Savoy, PhD, Human Factors Engineer, research scientist at the Regenstrief Institute and lead author of this second study, noted that it can be easier for consumers to find a pair of shoes in the size, color, and style they want online than it does PCPs to order specialist advice or a drug refill. Sorting through multiple systems and tabs to access clinical information can result in larger ones Hospital load.

“Current EHRs clutter GPs with information in disparate files and folders rather than presenting rich, actionable data in a meaningful context,” said Savoy.

In well being care, extra money is being spent on sufferers’ social wants. Is it working?

  • By Phil Galewitz/Kaiser Health News

June 21, 2021 | 12:14 PM

When doctors at a primary care clinic in Philadelphia noticed many of its poorest patients were failing to show up for appointments, they hoped giving out free rides would help.

But the one-time complimentary ride didn’t reduce these patients’ 36% no-show rate at the University of Pennsylvania Health System clinics.

“I was super surprised it did not have any effect,” says Dr. Krisda Chaiyachati, the Penn researcher who led the 2018 study of 786 Medicaid patients.

Many of the patients did not take advantage of the ride because they were either saving it for a more important medical appointment, or preferred their regular travel method, such as catching a ride from a friend, a subsequent study found.

It was not the first time that efforts by a health care provider to address patients’ social needs — such as food, housing and transportation— failed to work.

In the past decade, dozens of studies funded by state and federal governments, private hospitals, insurers and philanthropic organizations have looked into whether addressing patients’ social needs improves health and lowers medical costs.

But so far it’s unclear which of these strategies, focused on so-called social determinants of health, are most effective or feasible, according to several recent academic reports that evaluated existing research on the interventions. The reports were produced by experts at Columbia, Duke and the University of California-San Francisco.

The new reports found that even when such interventions show promising results, they usually serve only a small number of patients. Another challenge is that several studies did not go on long enough to detect an impact, or they did not evaluate health outcomes or health costs.

“We are probably at a peak of inflated expectations, and it is incumbent on us to find the innovations that really work,” says Dr. Laura Gottlieb, director of the UCSF Social Interventions Research and Evaluation Network. “Yes, there’s a lot of hype, and not all of these interventions will have staying power.”

But because health care providers and insurers are so eager to find ways to lower costs, the limited success of social-need interventions has done little to slow the surge of pilot programs — fueled by billions of private and government dollars.

Paying for health, not just health care

Across the country, both public and private health insurance programs are launching large initiatives aimed at improving health by helping patients with unmet social needs. One of the biggest efforts kicks off next year in North Carolina, which is spending $650 million over five years to test the effect of giving Medicaid enrollees assistance with housing, food and transportation.

California is redesigning its Medicaid program, which covers nearly 14 million residents, to dramatically increase social services to enrollees.

These moves mark a major turning point for Medicaid, which, since its inception in 1965, largely has prohibited government spending on most nonmedical services. To get around this, states have in recent years sought waivers from the federal government and pushed private Medicaid health plans to address enrollees’ social needs.

The move to address social needs is gaining steam nationally because, after nearly a dozen years focused on expanding insurance under the Affordable Care Act, many experts and policymakers agree that simply increasing access to health care is not nearly enough to improve patients’ health.

That’s because people don’t just need access to doctors, hospitals and drugs to be healthy, they also need healthy homes, healthy food, adequate transportation and education, a steady income, safe neighborhoods and a home life free from domestic violence — things hospitals and doctors can’t provide, but that in the long run are as meaningful as an antibiotic or an annual physical.

Researchers have known for decades that social problems such as unstable housing and lack of access to healthy foods can significantly affect a patient’s health, but efforts by the health industry to take on these challenges didn’t really take off until 2010 with the passage of the ACA. The law spurred changes in how insurers pay health providers — moving them away from receiving a set fee for each medical service, to payments based on value and patient outcomes.

As a result, hospitals now have a financial incentive to help patients with nonclinical problems — such as housing and food insecurity — that can affect health.

Temple University Health System in Philadelphia launched a two-year program last year to help 25 homeless Medicaid patients who frequently use its emergency room and other ERs in the city. The program provides the 25 patients with free housing, and caseworkers to help them access other health and social services. For example, the caseworkers can help with furnishing the new apartments, setting up healthy delivered meals, and submitting applications for income assistance such as Social Security.

To qualify, participants had to have visited the emergency room at least four times in the previous year, with medical claims exceeding $10,000 for that year.

Temple has seen promising results when comparing patients’ experience before the study to the first five months they were all housed. In that time, the participants’ average number of monthly ER visits fell 75% and inpatient hospital admissions dropped 79%.

At the same time, their use of outpatient services jumped by 50% — an indication that patients are seeking more appropriate and lower-cost settings for medical care.

Living life as ‘normal people do’

One participant is Rita Stewart, 53, who now lives in a one-bedroom apartment in Philadelphia’s Squirrel Hill neighborhood, home to many college students and young families.

“Everyone knows everyone,” Stewart says excitedly from her second-floor walk-up. It’s “a very calm area, clean environment. And I really like it.”

Before joining the Temple program last July and getting housing assistance, Stewart was living in a substance abuse recovery home. She had spent a few years bouncing among friends’ homes and other recovery centers. Once she slept overnight in the city bus terminal.

In 2019, Stewart had visited the Temple ER four times for various health concerns, including the flu, anxiety, and a heart condition.

Now, Stewart meets with her caseworkers at least once a week for help scheduling doctor appointments, arranging group counseling sessions and managing household needs.

“It’s a blessing,” she says from her apartment, with its small kitchen and comfortable couch.

“I have peace of mind that I am able to walk into my own place, leave when I want to, sleep when I want to,” Stewart says. “I love my privacy. I just look around and just — wow. I am grateful.”

Temple University Health System helped Rita Stewart get a one-bedroom apartment in Philadelphia’s Squirrel Hill neighborhood. Stewart and other patients in Temple’s housing assistance program have since stabilized their lives and avoided unnecessary ER visits. (Kimberly Paynter/WHYY)

Stewart has sometimes worked as a nursing assistant and has gotten her health care through Medicaid for years. She still deals with depression, she says, but having her own home has improved her mood. And the program has helped keep her out of the hospital.

“This is a chance for me to take care of myself better,” she says.

Her apartment assistance is set to end next year, when the Temple program ends, but administrators say they hope to find all the participants permanent housing and jobs.

“Hopefully that will work out and I can just live my life like normal people do and take care of my priorities and take care of my bills and things that a normal person would do,” Stewart says.

“Housing is the second-most impactful social determinant of health after food security,” says Steven Carson, a senior vice president at Temple University Health System. “Our goal is to help them bring meaningful and lasting health improvement to their lives.”

Success with social interventions doesn’t come cheap

Temple is helping pay for the program; other funding comes from two Medicaid health plans, a state grant and a Pittsburgh-based foundation. A nonprofit human services organization helps operate the program.

Program leaders hope the positive results will attract additional financing so they can expand to help many more homeless patients.

The effort is expensive. The “Housing Smart” program cost $700,000 to help 25 people for one year, or $28,000 per person. To put this in perspective, a single ER visit can cost a couple of thousands of dollars. And “frequent flyer” patients can rack up health care bills many times that amount through ER visits and follow-up care.

If Temple wants to help dozens more patients with housing, it will need tens of millions of dollars more per year.

Still, Temple officials say they expect the effort will save money over the long run by reducing expensive hospital visits — but they don’t yet have the data to prove that.

The Temple program was partly inspired by a similar housing effort started at two Duke University clinics in Durham, North Carolina. That program, launched in 2016, has served 45 patients with unstable housing and has reduced their ER use. But it’s been unable to grow because housing funding remains limited. And without data showing the intervention saves on overall health care costs, the organizers have been unable to attract more financing.

Often there is a need to demonstrate an overall reduction in health care spending to attract Medicaid funding.

“We know homelessness is bad for your health, but we are in the early stages of knowing how to address it,” explains Dr. Seth Berkowitz, a researcher at the University of North Carolina-Chapel Hill.

Results remain to be seen

“We need to pay for health not just health care,” said Elena Marks, CEO of the Houston-based Episcopal Health Foundation, which provides grants to community clinics and organizations to help address the social needs of vulnerable populations.

The nationwide push to spend more on social services is driven first by the recognition that social and economic forces have a greater impact on health than do clinical services like doctor visits, Marks says. A second factor is that the U.S. spends far less on social services per capita compared with other large, industrialized nations.

“This is a new and emerging field,” Marks says, after reviewing the meta-evaluations of the many studies of social needs interventions. “The evidence is weak for some, mixed for some, and strong for a few areas.”

But despite incomplete evidence, Marks adds, the status quo isn’t working either: Americans generally have poorer health than their counterparts in other industrialized countries with more robust social services.

“At some point we keep paying you more and more, Mr. Hospital, and people keep getting less and less. So, let’s go look for some other solutions,” Marks says.

The COVID-19 pandemic has shined further light on the inequities in access to health services and sparked further interest in Medicaid programs to address social issues. Over half of states are implementing or expanding Medicaid programs that address social needs, according to a KFF study in October 2020. (The KHN newsroom is an editorially independent program of KFF.)

In many states, the Medicaid interventions are not intense: Often they involve simply screening patients for social needs problems or referring them to another agency for help. Only two states — Arizona and Oregon — require their Medicaid health plans to directly invest money into pilot programs to address the social problems that screenings reveal, according to a survey by consulting firm Manatt.

The Centers for Medicare & Medicaid Services, which is funding a growing number of efforts to help Medicaid patients with social needs, said it “remains committed” to helping states meet enrollees’ social challenges including education, employment and housing.

On Jan. 7, CMS officials under the Trump administration sent guidance to states to accelerate these interventions. In May, under President Joe Biden, a CMS spokesperson told KHN:

“Evidence indicates that some social interventions targeted at Medicaid and CHIP beneficiaries can result in improved health outcomes and significant savings to the health care sector.”

The agency cited a 2017 survey of 17 state Medicaid directors in which most reported they recognized the importance of social determinants of health. The directors also noted barriers to address them, such as cost and sustainability.

In Philadelphia, Temple officials now face the challenge of finding new financing to keep their housing program going.

“We are trying to find the magic sauce to keep this program running,” says Patrick Vulgamore, project manager for Temple’s Center for Population Health.

Sojourner Ahébée contributed to this report. She is the health equity fellow at “The Pulse,” WHYY’s health and science show.

This Shots story was produced as part of NPR’s health reporting partnership with WHYY and KHN (Kaiser Health News).

In Alleged Well being Care ‘Cash Seize,’ Nation’s Largest Hospital Chain Cashes In on Trauma Facilities

After falling from a ladder and cutting his arm, Ed Knight said, he found himself at Richmond, Virginia’s Chippenham Hospital surrounded by nearly a dozen doctors, nurses and technicians — its crack “trauma team” charged with saving the most badly hurt victims of accidents and assaults.

But Knight’s wound, while requiring about 30 stitches, wasn’t life-threatening. Hospital records called it “mild.” The people in white coats quickly scattered, he remembered, and he went home about three hours later.

“Basically, it was just a gash on my arm,” said Knight, 71. “The emergency team that they assembled didn’t really do anything.”

Nevertheless, Chippenham, owned by for-profit chain HCA Healthcare, included a $17,000 trauma team “activation” fee on Knight’s bill, which totaled $52,238 and included three CT scans billed at $14,000. His care should have cost closer to $3,500 total, according to claims consultant WellRithms, which analyzed the charges for KHN.

HCA Healthcare’s activation fees run as high as $50,000 per patient and are sometimes 10 times greater than those at other hospitals, according to publicly posted price lists. Such charges have made trauma centers, once operated mainly by established teaching hospitals, a key part of the company’s growth and profit-generating strategy, corporate officials have said. HCA’s stock has doubled in three years. The biggest U.S. hospital operator along with the Department of Veterans Affairs, HCA has opened trauma centers in more than half its 179 hospitals and says it runs 1 of every 20 such facilities in the country.

And it’s not slowing down.

HCA “has basically taken a position that all of their hospitals should be trauma centers,” said Dr. Robert Winchell, describing conversations he had with HCA officials. Winchell is a trauma surgeon and former chairman of the trauma evaluation and planning committee at the American College of Surgeons.

Trauma patients are typically those severely injured in automobile accidents or falls or wounded by knives or guns.

State or local regulators confer the designation “trauma center,” often in concert with standards verified by the American College of Surgeons. The status allows a cascade of lucrative reimbursement, including activation fees billed on top of regular charges for medical care. Trauma centers are mostly exempt from 1970s-era certificate-of-need laws enacted to limit excessive hospital spending and expansion. The bills for all this — reaching into tens of thousands of dollars — go to private insurers, Medicare or Medicaid, or patients themselves.

“Once a hospital has a trauma designation, it can charge thousands of dollars in activation fees for the same care seen in the same emergency room,” said Stacie Sasso, executive director of the Health Services Coalition, made up of unions and employers fighting trauma center expansion by HCA and others in Nevada.

HCA’s expansion into trauma centers alarms health policy analysts who suggest its motive is more about chasing profit than improving patient care. Data collected by the state of Florida, analyzed by KHN, shows that regional trauma cases and expensive trauma bills rise sharply after HCA opens such centers, suggesting that many patients classified as trauma victims would have previously been treated less expensively in a regular emergency room.

Patients admitted to HCA and other for-profit hospitals in Florida with a trauma-team activation were far more likely to be only mildly or moderately injured than those at not-for-profit hospitals, researchers have found.

HCA is “cherry-picking patients,” said Ed Jimenez, CEO of the University of Florida Health Shands, which runs a Level I trauma center, the highest designation. “What you find is an elderly person who fell and broke their hip who could be perfectly well treated at their local hospital now becomes a trauma patient.”

HCA’s trauma center expansion makes superior care available to more patients, providing “lifesaving clinical services while treating all critically injured patients,” said company spokesperson Harlow Sumerford.

Richmond’s population “is booming,” said Chippenham spokesperson Jeffrey Caldwell. “This increase in demand requires that the regional health care system keep up.”

Trauma Is Big Business

HCA’s trauma center boom picked up speed in Florida a decade ago and has spread to its hospitals in Virginia, Nevada, Texas and other states. It has sparked fierce fights over who handles highly profitable trauma cases and debates over whether costs will soar and care suffer when rival centers go head-to-head competing for patients.

“There’s no question it’s a money grab” by HCA, said Jimenez, who was part of a largely unsuccessful effort to stop HCA’s trauma center expansion in Florida. “It was clear that their trauma activation fees were five or six times larger than ours.”

In a process shielded from public view in Virginia, Chippenham recently applied for and won the highest trauma center designation, Level I, providing the most sophisticated care — and putting it squarely in competition with nearby VCU Health. VCU has run the region’s only Level I facility for decades. In October, Chippenham announced a contract for its own helicopter ambulance, which gives it another way to increase its trauma business, by flying patients in from miles away. The Virginia Department of Health rejected KHN’s request to review HCA’s Chippenham trauma center application and related documents.

“This is a corporate strategy” by HCA “to grow revenue, maximize reimbursement and meet the interest of stockholders,” said Dr. Arthur Kellermann, CEO of VCU Health, who says his nonprofit, state-run facility is sufficient for the region’s trauma care needs. “Many people in the state should be concerned that the end result will be a dilution of care, higher costs and poorer outcomes.”

Chippenham’s Caldwell said the “redundancy” with VCU “allows the region to be better prepared for mass trauma events.”

Studies show trauma centers need high volumes of complex cases to stay sharp. Researchers call it the “practice makes perfect” effect. Patients treated for traumatic brain injuries at hospitals seeing fewer than six such cases a year died at substantially higher rates than such patients in more experienced hospitals, according to a 2013 study published in the Journal of Neurosurgery.

Another study, published in the Annals of Surgery, showed that a decrease as small as 1% in trauma center volume — because of competition or other reasons — substantially increased the risk that patients would die.

By splitting a limited number of cases, a competing, cross-town trauma center could set the stage for subpar results at both hospitals, goes the argument. The number of VCU’s admitted adult trauma patients decreased from nearly 3,600 in 2014, before Chippenham attained Level II status, to 3,200 in 2019, VCU officials said.

Chippenham was the only Level I center in Virginia that declined to disclose its trauma patient volume to KHN.

“People are trying to push the [trauma center] designation process beyond what may be good for the major hospitals that are already providing trauma care,” said Dr. David Hoyt, executive director of the American College of Surgeons, speaking generally. Local authorities who make those decisions, he said, can be “pressured by a hospital system that has a lot of economic pull in a community.”

Unlike regular emergency departments, Level I and Level II trauma centers make trauma surgeons, neurosurgeons and special equipment available round-the-clock. Centers with Levels III or IV designations offer fewer services but are still more capable than many emergency rooms, with round-the-clock lab services and extra training, for example.

Hospitals defend trauma team activation fees as necessary to cover the overhead of having a team of elite emergency specialists at the ready. At HCA hospitals they can run more than $40,000 per case, according to publicly posted charge lists, although the amount paid by insurers and patients is often less, depending on the coverage.

“Fees associated with trauma activation are based on our costs to immediately deploy lifesaving resources and measures 24/7,” said HCA spokesperson Sumerford, adding that low-income and uninsured patients often pay nothing for trauma care. “What patients actually pay for their hospital care has more to do with their insurance plan” than the total charges, he said.

There is no standard accounting for trauma-related costs incurred by hospitals. One method involves multiplying hourly pay for members of the trauma team by the potential hours worked. Hospitals don’t reveal calculations, but the wide variation in fees suggests they are often set with an eye on revenue rather than true costs, say industry analysts.

Reasonable charges for Knight’s total bill would have been $3,537, not $52,238, according to the analysis by WellRithms, a claims consulting firm that examined his medical records and Chippenham’s costs filed with Medicare. Given his minor injury, the $17,000 trauma activation fee “is not necessary,” said Dr. Ira Weintraub, WellRithms’ chief medical officer.

Often insurers pay substantially less than billed charges, especially Medicare, Knight’s insurer. He paid nothing out-of-pocket, and Chippenham collected a total of $1,138 for his care, HCA officials said after this article was initially published. But hospitals can maximize revenue by charging high trauma fees to all insurers, including those required to pay a percentage of charges, say medical billing consultants.

VCU Health charges up to $13,455 for trauma activation, according to its charge list.

Average HCA trauma activation charges are $26,000 in states where the company does business — three times higher than those of non-HCA hospitals, according to data from Hospital Pricing Specialists, a consulting firm that analyzed trauma charges in Medicare claims for KHN.

The findings are similar to those reported by the Tampa Bay Times in 2014, early in HCA’s trauma center expansion. The Times found that Florida HCA trauma centers were charging patients and insurers tens of thousands of dollars more per case than other hospitals.

Treating trauma patients in the ER is only the beginning of the revenue stream. Intensive inpatient treatment and long patient recoveries add to the income.

“We have more Level I, Level II trauma centers today than we have ever had in the company history,” HCA’s then-CEO, Milton Johnson, told stock analysts in 2016. “That strategy in turn feeds surgical growth. That strategy in turn feeds neurosciences growth, it feeds rehab growth.” Trauma centers attract “a certain cadre of high-value patients,” Dr. Jonathan Perlin, HCA’s chief medical officer, told analysts at a 2017 conference.

Patients at HCA’s largely suburban hospitals are more likely than those at an average hospital to carry private insurance, which pays much more than Medicare and Medicaid. More than half the company’s revenue in 2020 came from private insurers, regulatory filings show. Hospitals, in general, collect a little more than a third of their revenue from private insurers, according to the Department of Health and Human Services.

HCA’s trauma cases can fit the same profile. At Chippenham, in south Richmond, trauma cases are “90% blunt trauma,” according to the hospital’s online job posting last year for a trauma medical director. Blunt-trauma patients are generally victims of car accidents and falls and tend to have good insurance, analysts say.

VCU and other urban hospitals, on the other hand, treat a higher share of patients with gun and knife injuries — penetrating trauma — who are more often uninsured or covered by Medicaid. About 75% of VCU’s trauma cases are classified as blunt trauma, hospital officials said.

The 90% figure is “not accurate today,” Caldwell said. “Chippenham’s current mix of trauma type is aligned with that of other trauma centers in the region, and we treat traumas ranging from motor vehicle accidents to gunshots, stabbings and other critical injuries regularly.”

‘Trauma Drama’ in Florida and Beyond

HCA’s growth strategy is part of a wider trend. From 2010 to 2020 the number of Level I and Level II trauma centers verified by the American College of Surgeons nationwide increased from 343 to 567.

Nowhere has HCA added trauma centers more aggressively or the fight over trauma center growth been more acrimonious than in Florida. The state’s experience over the past decade may offer a preview of what’s to come in Virginia and elsewhere.

In the thick of the controversy, legislators stepped in to broker a 2018 truce — but only after the number of HCA trauma centers in the state had grown from one to 11 over more than a decade and helped spark an explosion in trauma cases, according to Florida Department of Health data.

News headlines called it “trauma drama.” Hospitals with existing centers repeatedly filed legal challenges to stop the expansion, with little effect. Florida’s governor at the time was Rick Scott, former chief executive of Columbia/HCA, a predecessor company to HCA.

After launching Level II centers across the state, HCA officials urged Florida regulators not to adopt CDC guidelines recommending severely injured patients be treated at the highest level of trauma care in a region — Level I, if available.

HCA “kept on working, working, working, working for 10 years” to gain trauma center approvals over objections, said Mark Delegal, who helped broker the legislative settlement as a lobbyist for large safety-net hospitals. “Once they had what they wanted, they were happy to lock the door behind them.”

HCA hospitals “serve the health care needs of their communities and adjust or expand services as those needs evolve,” said Sumerford.

As HCA added trauma centers, trauma-activation billings and the number of trauma cases spiked, according to Florida Department of Health data analyzed by KHN. Statewide, inpatient trauma cases doubled to 35,102 in the decade leading up to 2020, even though the population rose by only 15%. HCA’s share of statewide trauma cases jumped from 4% to 24%, the data shows.

Charges for trauma activations, also known as trauma alerts, for HCA’s Florida hospitals averaged $26,890 for inpatients in 2019 while the same fees averaged $9,916 for non-HCA Florida hospitals, the data shows. Total average charges, including medical care, were $282,600 per case in 2019 for inpatient trauma cases at HCA hospitals, but $139,000 for non-HCA hospitals.

HCA’s substantially higher charges didn’t necessarily result from patients with especially severe injuries, public university research found.

Over three years ending in 2014, Florida patients with sprains, mild cuts and other non-life-threatening injuries were “significantly more likely” to be admitted under trauma alerts at HCA hospitals and other for-profit hospitals than at nonprofit hospitals, according to research by University of South Florida economist Etienne Pracht and colleagues. HCA hospitals have admitted emergency department Medicare patients at substantially higher-than-average rates since 2011, suggesting that at other hospitals many would have been sent home, new research by the Service Employees International Union found.

“What’s going on with HCA is the Wall Street model they’re following,” said Pracht, who provided KHN with additional Florida Department of Health data showing soaring trauma cases. “And Wall Street’s not happy unless you’re expanding. They’re driven by the motive to keep the stock price high.”

Lobbying and Campaign Dollars

In Virginia, health care organizations need to go through a lengthy and public application process to add something as basic as a $1 million MRI imaging machine.

But to open or upgrade a trauma center, all that’s needed is the approval of the health commissioner after a confidential qualification procedure. Chippenham did not seek or obtain Level I verification from the American College of Surgeons before getting Level I approval from the state. It is ACS-verified as a Level II center and, Caldwell said, is seeking Level I status with ACS.

Virginia requires an “extensive application” and “in-depth” site reviews by experts before a hospital gains status as a trauma center, Dr. M. Norman Oliver, the commissioner, said in an email. “Chippenham Hospital met the requirements” to become a Level I center, he said.

Nearly 80% of HCA’s Level I and Level II trauma centers have been verified by the American College of Surgeons “and the others currently are pursuing this verification,” said HCA spokesperson Sumerford.

As in other states, HCA invests heavily in Virginia in political influence. Eleven Virginia lobbyists are registered with the state to advocate on HCA’s behalf. One lobbyist spent more than $5,000 from December 2019 through February 2020 treating public officials to reception spreads and meals at posh Richmond restaurants such as L’Opossum and Morton’s the Steakhouse, lobbying records submitted to Virginia’s Conflict of Interest and Ethics Advisory Council show. HCA’s political action committee donated $160,000 to state candidates last year, according to the records.

Like other hospital systems, HCA hires former paramedics for “EMS relations” or “EMS outreach” jobs. HCA’s EMS liaisons are expected to develop a “business plan, driving service line growth,” according to its employment ads.

Chippenham’s decision to start a helicopter ambulance operation last year to compete with others in transporting trauma patients surprised some public officials. HCA and its contractor had filed paperwork for the operation to be reimbursed by insurers when Richmond City Council members learned about it. Members “were not up to speed on this matter,” council member Kristen Larson told a May 2020 meeting of the Richmond Ambulance Authority, according to the minutes.

Chippenham’s air ambulance partner, private equity-owned Med-Trans, has been the subject of numerous media reports of patients saddled with tens of thousands of dollars in out-of-network surprise bills. It’s not unusual for air ambulances to charge $30,000 or more for transporting a patient from a highway accident or just across town, according to news reports.

Last year, 85% of Med-Trans flights for Virginia patients with health insurance were in-network, said a company spokesperson. But Med-Trans is out of network for Virginia members of Aetna and UnitedHealthcare, two of the state’s biggest carriers, said spokespeople for those companies. Med-Trans is part of Anthem Blue Cross Blue Shield’s network, an Anthem spokesperson said.

HCA runs trauma centers “really well,” said Winchell, who runs the Level I trauma center at NewYork-Presbyterian Weill Cornell Medical Center.

But “there are clearly areas of oversupply” for trauma centers generally, he said.

Instead of letting a drive for profits dictate trauma center expansion, health authorities need “objective and transparent metrics” to guide the designation of trauma centers, Winchell recently wrote in the Journal of the American College of Surgeons.

Free-market advocate “Adam Smith might have been a good economist,” he wrote, “but he would have been a very poor designer of trauma systems.”

KHN data editor Elizabeth Lucas contributed to this report.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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This story can be republished for free (details).

In alleged well being care ‘cash seize,’ nation’s largest hospital chain cashes in on trauma facilities

After falling from a ladder and cutting his arm, Ed Knight said he found himself at Richmond’s Chippenham Hospital surrounded by nearly a dozen doctors, nurses and technicians — its crack “trauma team” charged with saving the most badly hurt victims of accidents and assaults.

But Knight’s wound, while requiring about 30 stitches, wasn’t life-threatening. Hospital records called it “mild.” The people in white coats quickly scattered, he remembered, and he went home about three hours later.

“Basically, it was just a gash on my arm,” said Knight, 71. “The emergency team that they assembled didn’t really do anything.”

Nevertheless, Chippenham, owned by for-profit chain HCA Healthcare, included a $17,000 trauma team “activation” fee on Knight’s bill, which totaled $52,238 and included three CT scans billed at $14,000. His care should have cost closer to $3,500 total, according to claims consultant WellRithms, which analyzed the charges for KHN.

Ed Knight was taken to Chippenham Hospital after cutting his arm in a fall from a ladder. For stitching up Knight's wound and sending him home after a few hours, Chippenham Hospital's charges exceeded $50,000, according to a claims document in the case.Ed Knight was taken to Chippenham Hospital after cutting his arm in a fall from a ladder. For stitching up Knight’s wound and sending him home after a few hours, Chippenham Hospital’s charges exceeded $50,000, according to a claims document in the case. [ JULIA RENDLEMAN | Julia Rendleman for Kaiser Health News ]

HCA Healthcare’s activation fees run as high as $50,000 per patient and are sometimes 10 times greater than those at other hospitals, according to publicly posted price lists. Such charges have made trauma centers, once operated mainly by established teaching hospitals, a key part of the company’s growth and profit-generating strategy, corporate officials have said. HCA’s stock has doubled in three years.

The biggest U.S. hospital operator along with the Department of Veterans Affairs, HCA has opened trauma centers in more than half its 179 hospitals. It operates trauma centers at 11 of its more than 40 Florida hospitals and says it runs 1 of every 20 such facilities in the country.

And it’s not slowing down.

HCA “has basically taken a position that all of their hospitals should be trauma centers,” said Dr. Robert Winchell, describing conversations he had with HCA officials. Winchell is a trauma surgeon and former chairman of the trauma evaluation and planning committee at the American College of Surgeons.

Average HCA trauma activation charges are $26,000 in states where the company does business — three times higher than those of non-HCA hospitals, according to data from Hospital Pricing Specialists, a consulting firm that analyzed trauma charges in Medicare claims for KHN.

The findings are similar to those reported by the Tampa Bay Times in 2014, early in HCA’s trauma center expansion. The Times found that Florida HCA trauma centers were charging patients and insurers tens of thousands of dollars more per case than other hospitals.

Related: How HCA turned trauma into a money-maker

Trauma patients are typically those severely injured in automobile accidents or falls or wounded by knives or guns.

State or local regulators confer the designation “trauma center,” often in concert with standards verified by the American College of Surgeons. The status allows a cascade of lucrative reimbursement, including activation fees billed on top of regular charges for medical care. Trauma centers are mostly exempt from 1970s-era certificate-of-need laws enacted to limit excessive hospital spending and expansion. The bills for all this — reaching into tens of thousands of dollars — go to private insurers, Medicare or Medicaid, or patients themselves.

“Once a hospital has a trauma designation, it can charge thousands of dollars in activation fees for the same care seen in the same emergency room,” said Stacie Sasso, executive director of the Health Services Coalition, made up of unions and employers fighting trauma center expansion by HCA and others in Nevada.

HCA’s expansion into trauma centers alarms health policy analysts who suggest its motive is more about chasing profit than improving patient care. Data collected by the state of Florida, analyzed by KHN, shows that regional trauma cases and expensive trauma bills rise sharply after HCA opens such centers, suggesting that many patients classified as trauma victims would have previously been treated less expensively in a regular emergency room.

Patients admitted to HCA and other for-profit hospitals in Florida with a trauma-team activation were far more likely to be only mildly or moderately injured compared with those at not-for-profit hospitals, researchers have found.

HCA is “cherry-picking patients,” said Ed Jimenez, CEO of the University of Florida Health Shands, which runs a Level I trauma center, the highest designation. “What you find is an elderly person who fell and broke their hip who could be perfectly well treated at their local hospital now becomes a trauma patient.”

HCA’s trauma center expansion makes superior care available to more patients, providing “lifesaving clinical services while treating all critically injured patients,” said company spokesperson Harlow Sumerford.

Richmond’s population “is booming,” said Chippenham spokesperson Jeffrey Caldwell. “This increase in demand requires that the regional health care system keep up.”

Trauma is big business

HCA’s trauma center boom picked up speed in Florida a decade ago and has spread to its hospitals in Virginia, Nevada, Texas and other states. It has sparked fierce fights over who handles highly profitable trauma cases and debates over whether costs will soar and care suffer when rival centers go head-to-head competing for patients.

“There’s no question it’s a money grab” by HCA, said Jimenez, who was part of a largely unsuccessful effort to stop HCA’s trauma center expansion in Florida. “It was clear that their trauma activation fees were five or six times larger than ours.”

In a process shielded from public view in Virginia, Chippenham recently applied for and won the highest trauma center designation, Level I, providing the most sophisticated care — and putting it squarely in competition with nearby VCU Health. VCU has run the region’s only Level I facility for decades. In October, Chippenham announced a contract for its own helicopter ambulance, which gives it another way to increase its trauma business by flying patients in from miles away. The Virginia Department of Health rejected KHN’s request to review HCA’s Chippenham trauma center application and related documents.

“This is a corporate strategy” by HCA “to grow revenue, maximize reimbursement and meet the interest of stockholders,” said Dr. Arthur Kellermann, CEO of VCU Health, who says his nonprofit, state-run facility is sufficient for the region’s trauma care needs. “Many people in the state should be concerned that the end result will be a dilution of care, higher costs and poorer outcomes.”

Chippenham’s Caldwell said the “redundancy” with VCU “allows the region to be better prepared for mass trauma events.”

Studies show trauma centers need high volumes of complex cases to stay sharp. Researchers call it the “practice makes perfect” effect. Patients treated for traumatic brain injuries at hospitals seeing fewer than six such cases a year died at substantially higher rates than such patients in more experienced hospitals, according to a 2013 study published in the Journal of Neurosurgery.

Another study, published in the Annals of Surgery, showed that a decrease as small as 1% in trauma center volume — because of competition or other reasons — substantially increased the risk that patients would die.

By splitting a limited number of cases, a competing, cross-town trauma center could set the stage for subpar results at both hospitals, goes the argument. The number of VCU’s admitted adult trauma patients decreased from nearly 3,600 in 2014, before Chippenham attained Level II status, to 3,200 in 2019, VCU officials said.

Chippenham was the only Level I center in Virginia that declined to disclose its trauma patient volume to KHN.

“People are trying to push the [trauma center] designation process beyond what may be good for the major hospitals that are already providing trauma care,” said Dr. David Hoyt, executive director of the American College of Surgeons, speaking generally. Local authorities who make those decisions, he said, can be “pressured by a hospital system that has a lot of economic pull in a community.”

Unlike regular emergency departments, Level I and Level II trauma centers make trauma surgeons, neurosurgeons and special equipment available around the clock. Centers with Levels III or IV designations offer fewer services but are still more capable than many emergency rooms, with round-the-clock lab services and extra training, for example.

Hospitals defend trauma team activation fees as necessary to cover the overhead of having a team of elite emergency specialists at the ready. At HCA hospitals they can run more than $40,000 per case, according to publicly posted charge lists, although the amount paid by insurers and patients is often less, depending on the coverage.

“Fees associated with trauma activation are based on our costs to immediately deploy lifesaving resources and measures 24/7,” said HCA spokesperson Sumerford, adding that low-income and uninsured patients often pay nothing for trauma care. “What patients actually pay for their hospital care has more to do with their insurance plan” than the total charges, he said.

There is no standard accounting for trauma-related costs incurred by hospitals. One method involves multiplying hourly pay for members of the trauma team by the potential hours worked. Hospitals don’t reveal calculations, but the wide variation in fees suggests they are often set with an eye on revenue rather than true costs, say industry analysts.

Reasonable charges for Knight’s total bill would have been $3,537, not $52,238, according to the analysis by WellRithms, a claims consulting firm that examined his medical records and Chippenham’s costs filed with Medicare. Given his minor injury, the $17,000 trauma activation fee “is not necessary,” said Dr. Ira Weintraub, WellRithms’ chief medical officer.

Often insurers pay substantially less than billed charges, especially Medicare, Knight’s insurer. He paid nothing out-of-pocket, and Chippenham collected a total of $1,138 for his care, HCA officials said after this article was initially published. But hospitals can maximize revenue by charging high trauma fees to all insurers, including those required to pay a percentage of charges, say medical billing consultants.

VCU Health charges up to $13,455 for trauma activation, according to its charge list.

Average HCA trauma activation charges are $26,000 in states where the company does business — three times higher than those of non-HCA hospitals, according to data from Hospital Pricing Specialists, a consulting firm that analyzed trauma charges in Medicare claims for KHN.

Treating trauma patients in the ER is only the beginning of the revenue stream. Intensive inpatient treatment and long patient recoveries add to the income.

“We have more Level I, Level II trauma centers today than we have ever had in the company history,” HCA’s then-CEO, Milton Johnson, told stock analysts in 2016. “That strategy in turn feeds surgical growth. That strategy in turn feeds neurosciences growth, it feeds rehab growth.” Trauma centers attract “a certain cadre of high-value patients,” Dr. Jonathan Perlin, HCA’s chief medical officer, told analysts at a 2017 conference.

Patients at HCA’s largely suburban hospitals are more likely than those at an average hospital to carry private insurance, which pays much more than Medicare and Medicaid. More than half the company’s revenue in 2020 came from private insurers, regulatory filings show. Hospitals, in general, collect a little more than a third of their revenue from private insurers, according to the Department of Health and Human Services.

HCA’s trauma cases can fit the same profile. At Chippenham, in south Richmond, trauma cases are “90% blunt trauma,” according to the hospital’s online job posting last year for a trauma medical director. Blunt-trauma patients are generally victims of car accidents and falls and tend to have good insurance, analysts say.

VCU and other urban hospitals, on the other hand, treat a higher share of patients with gun and knife injuries — penetrating trauma — who are more often uninsured or covered by Medicaid. About 75% of VCU’s trauma cases are classified as blunt trauma, hospital officials said.

The 90% figure is “not accurate today,” Caldwell said. “Chippenham’s current mix of trauma type is aligned with that of other trauma centers in the region, and we treat traumas ranging from motor vehicle accidents to gunshots, stabbings and other critical injuries regularly.”

‘Trauma drama’ in Florida and beyond

HCA’s growth strategy is part of a wider trend. From 2010 to 2020 the number of Level I and Level II trauma centers verified by the American College of Surgeons nationwide increased from 343 to 567.

Nowhere has HCA added trauma centers more aggressively or the fight over trauma center growth been more acrimonious than in Florida. The state’s experience over the past decade may offer a preview of what’s to come in Virginia and elsewhere.

In the thick of the controversy, legislators stepped in to broker a 2018 truce — but only after the number of HCA trauma centers in the state had grown from one to 11 over more than a decade and helped spark an explosion in trauma cases, according to Florida Department of Health data.

News headlines called it “trauma drama.” Hospitals with existing centers repeatedly filed legal challenges to stop the expansion, with little effect. Florida’s governor at the time was Rick Scott, former chief executive of Columbia/HCA, a predecessor company to HCA.

After launching Level II centers across the state, HCA officials urged Florida regulators not to adopt CDC guidelines recommending severely injured patients be treated at the highest level of trauma care in a region — Level I, if available.

HCA “kept on working, working, working, working for 10 years” to gain trauma center approvals over objections, said Mark Delegal, who helped broker the legislative settlement as a lobbyist for large safety-net hospitals. “Once they had what they wanted, they were happy to lock the door behind them.”

HCA hospitals “serve the health care needs of their communities and adjust or expand services as those needs evolve,” said Sumerford.

As HCA added trauma centers, trauma-activation billings and the number of trauma cases spiked, according to Florida Department of Health data analyzed by KHN. Statewide, inpatient trauma cases doubled to 35,102 in the decade leading up to 2020, even though the population rose by only 15%. HCA’s share of statewide trauma cases jumped from 4% to 24%, the data shows.

Charges for trauma activations, also known as trauma-alerts, for HCA’s Florida hospitals averaged $26,890 for inpatients in 2019 while the same fees averaged $9,916 for non-HCA Florida hospitals, the data shows. Total average charges, including medical care, were $282,600 per case in 2019 for inpatient trauma cases at HCA hospitals, but $139,000 for non-HCA hospitals.

HCA’s substantially higher charges didn’t necessarily result from patients with especially severe injuries, public university research found.

Over three years ending in 2014, Florida patients with sprains, mild cuts and other non-life-threatening injuries were “significantly more likely” to be admitted under trauma alerts at HCA hospitals and other for-profit hospitals than at nonprofit hospitals, according to research by University of South Florida economist Etienne Pracht and colleagues. HCA hospitals have admitted emergency department Medicare patients at substantially higher-than-average rates since 2011, suggesting that at other hospitals many would have been sent home, new research by the Service Employees International Union found.

“What’s going on with HCA is the Wall Street model they’re following,” said Pracht, who provided KHN with additional Florida Department of Health data showing soaring trauma cases. “And Wall Street’s not happy unless you’re expanding. They’re driven by the motive to keep the stock price high.”

Lobbying and Campaign Dollars

In Virginia, health care organizations need to go through a lengthy and public application process to add something as basic as a $1 million MRI imaging machine.

But to open or upgrade a trauma center, all that’s needed is the approval of the health commissioner after a confidential qualification procedure. Chippenham did not seek or obtain Level I verification from the American College of Surgeons before getting Level I approval from the state. It is ACS-verified as a Level II center and, Caldwell said, is seeking Level I status with ACS.

Virginia requires an “extensive application” and “in-depth” site reviews by experts before a hospital gains status as a trauma center, Dr. M. Norman Oliver, the commissioner, said in an email. “Chippenham Hospital met the requirements” to become a Level I center, he said.

Nearly 80% of HCA’s Level I and Level II trauma centers have been verified by the American College of Surgeons “and the others currently are pursuing this verification,” said HCA spokesperson Sumerford.

As in other states, HCA invests heavily in Virginia in political influence. Eleven Virginia lobbyists are registered with the state to advocate on HCA’s behalf. One lobbyist spent more than $5,000 from December 2019 through February 2020 treating public officials to reception spreads and meals at posh Richmond restaurants such as L’Opossum and Morton’s the Steakhouse, lobbying records submitted to Virginia’s Conflict of Interest and Ethics Advisory Council show. HCA’s political action committee donated $160,000 to state candidates last year, according to the records.

Like other hospital systems, HCA hires former paramedics for “EMS relations” or “EMS outreach” jobs. HCA’s EMS liaisons are expected to develop a “business plan, driving service line growth,” according to its employment ads.

Chippenham’s decision to start a helicopter-ambulance operation last year to compete with others in transporting trauma patients surprised some public officials. HCA and its contractor had filed paperwork for the operation to be reimbursed by insurers when Richmond City Council members learned about it. Members “were not up to speed on this matter,” councilwoman Kristen Larson told a May 2020 meeting of the Richmond Ambulance Authority, according to the minutes.

Chippenham’s air ambulance partner, private equity-owned Med-Trans, has been the subject of numerous media reports of patients saddled with tens of thousands of dollars in out-of-network surprise bills. It’s not unusual for air ambulances to charge $30,000 or more for transporting a patient from a highway accident or just across town, according to news reports.

Last year, 85% of Med-Trans flights for Virginia patients with health insurance were in-network, said a company spokesperson. But Med-Trans is out of network for Virginia members of Aetna and UnitedHealthcare, two of the state’s biggest carriers, said spokespeople for those companies. Med-Trans is part of Anthem Blue Cross Blue Shield’s network, an Anthem spokesperson said.

HCA runs trauma centers “really well,” said Winchell, who runs the Level I trauma center at NewYork-Presbyterian Weill Cornell Medical Center.

But “there are clearly areas of oversupply” for trauma centers generally, he said.

Instead of letting a drive for profits dictate trauma center expansion, health authorities need “objective and transparent metrics” to guide the designation of trauma centers, Winchell recently wrote in the Journal of the American College of Surgeons.

Free-market advocate “Adam Smith might have been a good economist,” he wrote, “but he would have been a very poor designer of trauma systems.”

KHN data editor Elizabeth Lucas contributed to this report.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

ANALYSIS | Who In Well being Care Made Cash on COVID?

(Ravipat via Shutterstock)

ELLEN ANDREWS

Many COVID-19 heroes risk their lives or have died caring for others. We all owe great thanks to health care providers, scientists, public health professionals, and other frontline workers. But the health service was going well. Four of the 10 companies Those who have benefited most during the pandemic are in healthcare.

Pharmaceutical companies and their executives are the biggest COVID winners. Executives in the pharmaceutical industry could walk the federal government’s $ 22 billion COVID vaccine program, Operation Warp Speed, for being exempt from customary conflict of interest requirements. According to Nina Burleigh’s “Virus: Vaccinations, the CDC, and the Hijacking of America’s Response to the Pandemic” in Forbes, “Moderna and Pfizer executives cashed the vaccine and sold stocks that matched the clinical trial press releases.”

Pfizer’s pre-tax profit on his vaccine is estimated at $ 990 million. Unlike other companies, Pfizer doesn’t to take Federal funds to develop or manufacture the vaccine, but it received federal contracts for vaccine doses worth billions of dollars in taxpayers’ money. And Pfizer’s partner in vaccine development, BioNTech, received $ 445 million from the German government. Pfizer also received billions in private donations to develop and test the vaccine.

Pfizer isn’t the only pharmaceutical company that has benefited from this. In return for massive subsidies for Operation Warp Speed, Johnson & Johnson and AstraZeneca pledged not to benefit from their COVID vaccines during the pandemic. However, they didn’t need to share their vaccine knowledge at the taxpayers’ expense in order to help the public with the next pandemic. Both companies made huge profits during the pandemic, mostly from pharmaceuticals. Johnson & Johnson Net Income $ 6.2 billion in the first quarter of this year, up $ 400 million from the first quarter last year. AstraZenecas Operating profit was $ 1.9 billion for the first quarter of this year, roughly double last year. Moderna posted those from this company first quarterly Profit of $ 1.2 billion from its vaccine earlier this year.

Concerns at the start of the pandemic that insurers could be hit hard were misplaced. Insurers made big bucks in 2020 because providers canceled voting procedures at the start of the pandemic and consumers delayed routine supplies. For the first time in US history Health expenditure decreased in 2020. Because the Affordable Care Act limits the administration and profits of insurers, it is estimated that they must Return $ 2.14 billion this profits to consumers and payers. Insurers are expected to continue benefiting from COVID this year as federal policy changes in response to COVID and the effects of the recession, including higher enrollment on the exchanges and higher premium subsidies that apply to more people.

We won’t know until the fall of this year, but there are early signs that Connecticut hospitals and their major healthcare systems have also been spared financially last year. Connecticut hospitals received Over $ 1 billion in state and federal COVID relief funds. Unlike nursing homes and other health sectors Employment in the Connecticutut hospital has almost returned to pre-pandemic levels. US hospital expenses recovered to $ 60 billion in March this year, more than it did two years ago. COVID tests became a very profitable service for many hospitals.

Large health systems, mostly run by hospitals, are getting bigger Use of COVID aids buy more doctor’s offices. During this shift started in Connecticut before the pandemic, COVID has accelerated the trend. Find studies that this consolidation only increases prices and expenses without improving the quality of care. This COVID consequence could have lasting effects and accelerate rising healthcare costs in Connecticut far into the future.

COVID has been a terrible burden on frontline workers, vendors, and the economy, but it has been a boon to the healthcare industry.

Ellen Andrews, PhD, is the executive director of the CT project on health policy. Follow her on Twitter @CTHealthNotes.

The author’s views, opinions, positions, or strategies are solely his and do not necessarily reflect the views, opinions, or positions of CTNewsJunkie.com.

Well being care vs. Cash – WHYY

The United States spends more on health care than any other country in the world – and that spending is increasing every year. In some ways, that’s good news because it means new treatments, drugs, and tests are available and people are living longer. But it also means that health care and insurance are becoming more expensive. There is always pressure to control or reduce costs and find inefficiencies, which in many ways impacts patient care. In this episode we explore the intricate relationship between medicine and money. We hear how financial pressures led to maternity ward closings in Philadelphia – and the surprising results; how much effort a Canadian goes to get his life-saving medication; and the complicated financial realities of hospital operations.

Also heard in this week’s episode:

  • We speak to the NYU health economist Sherry limb about why the debate about for- and non-profit health care is more complicated than we might think, and how changes to the system can have unexpected effects.
  • UCLA Health Policy Expert, Jill Horvitz explains the difficult financial realities of hospital operations and how they weigh the costs and benefits of providing various services.
  • Reporter Jad Sleiman recalls his previous life as a paramedic to uncover one of the secrets of ambulance accounting.

Not simply $1,400 checks: Main well being care perks from the stimulus regulation may prevent cash

With the new business cycle accounting, you may be able to save money on health insurance this year.

Sarah Tew / CNET

Did you has still filed your taxes? If not, it’s time: Die The closing date for entries is Monday, May 17th Except for you File for an extension. But there is good news. Along with $ 1,400 stimulus checks and “Plus-Up” payments$ 300 extra per week in unemployment insurance and the one ahead monthly child tax credits for up to A total of $ 3,600 per child, the March stimulus law There are several ways that you can save money on healthcare costs, including deducting additional medical expenses from your tax return this year.

In 2021, the average cost of health insurance in the US is reported to be nearly $ 500 per person per month Worth penguinThe associated costs can add up gradually or all at once, including expensive premiums and taxes on purchases of medicines and other personal health items. The Boom Act offers people in need of health insurance and resources new ways to cut costs for those already insured.

Read on to learn how you can save money this year. Also, take two minutes See if your state owes you money. Here’s what we know about a potential fourth stimulus checknine strange stimulus check facts and where the current situation is Debt relief for student loans. This story was recently updated.

The COBRA insurance premiums are free until September

If you lose your job, you can usually get government insurance through your previous employer COBRA Program (Consolidated Omnibus Budget Reconciliation Act). However, you usually have to pay full price for this insurance, which can be very costly. Under the March Law, the government pays the entire COBRA premium for laid-off employees and family members from April 1 to September 30. (However, you will not be eligible if you have Medicare, left your job voluntarily, or if you qualify for new employer-based health insurance elsewhere before that date.)

The Economic Act stipulates that employers must send a declaration of eligibility to former employees who qualify for COBRA. But if you didn’t get that, you can call your previous employer to make sure you’re signed up for coverage.


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Stimulus Plus Up Payments: What You Need To Know

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You can now sign up for cheaper health insurance

As part of business cycle accounting, you may be eligible for new short-term health insurance grants for which you can purchase coverage HealthCare.gov. Almost everyone who takes out their own insurance through the Affordable Care Act has, according to a New York Times report.

The bill expands the health insurance subsidies available under the ACA so that people who are already eligible can receive more, and support can also be provided to those whose incomes were previously too high to qualify. For example, if your annual income is around $ 19,000, you can sign up for a plan with no monthly payment. If you make more than $ 51,000, your premium could drop as much as $ 1,000 per month in some markets, the Times reported. (For most people, subsidized health insurance eligibility is calculated based on your household’s modified information adjusted gross income, according to the UC Berkeley Labor Center.)

To take advantage of the new benefits, you need to register for plans at HealthCare.gov, or, for some statesto set up their own insurance market websites. The changes will take effect retrospectively as of January 1, 2021. So, if you already have a medical plan under the Affordable Care Act, you will get your money back as a refund when you file your tax return for 2021 next year.

The American Rescue Plan Act will fund these new grants for two years.

009-cash-money-stimulus-checks-bill-passed-congress-1400-dollar-payment-goal-supplement-bullseye-2021-Biden

You may be eligible for free COBRA coverage for the next six months.

Sarah Tew / CNET

Deduct major medical expenses from your taxes

Some medical expenses are tax deductible – and Congress passed a more generous allowance for what you can deduct as part of the cost December Stimulus Act.

Instead of capping costs that exceed 10% of your costs adjusted gross incomeAs originally planned, you can now deduct medical expenses that exceed 7.5% of your AGI. You can find the full list of medical expenses that you can deduct on the IRS website, including medical fees and inpatient hospital care.


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Child Tax Credit: How Much Do You Get?

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Add more money to your flexible health spending plan, tax-free

If you have a healthcare FSA, good news: the tax-free contribution limit has increased to $ 2,750 – up $ 50 from last year. The change was part of the IRS annual inflation adjustments. That means you can put more money into your account without being taxed on it.

Use open insurance registration through August

While you typically have to wait for the six-week open enrollment period every fall to sign up for health insurance, the American Rescue Plan Act created a special enrollment period that runs through mid-August.

Most state marketplaces have done the same. That said, you can go to HealthCare.gov or your state option and sign up for insurance now if needed and take advantage of the new subsidies and changes. That way, you can save money by signing up for a cheaper plan sooner.

For more information, see Who Is Eligible for the Child Extended Tax Credit? and Seven other ways you can get more money back on your tax refund.

Track the coronavirus pandemic.

Native physician elevating cash to ship wanted medical provides to India | Well being Care

For more than a year, Dr. Darshan Shah at the forefront of the local fight against the COVID-19 pandemic.

However, Shah was forced to watch from a distance as the virus decimates his homeland, India, whose health system is overwhelmed by a record number of new infections and deaths. To date, more than 21 million infections and more than 234,000 deaths have been reported. Experts believe these are likely to be enormous Subcounts.

Shah said the “whole nation is turning into a cemetery.”

“It’s utterly terrible and now, in the past two or three weeks, it’s just over the turning point,” said Shah, a pediatric professor and doctor at East Tennessee State University. Shah said the situation was “mind-boggling”, describing it as a “tsunami” of infections and deaths that has made some of his family members sick and claimed the lives of another.

“It’s very, very difficult,” said Shah as he watched the situation develop from thousands of kilometers away.

India’s coronavirus surge began in February and has devastated the country’s health system – with medical oxygen and other life-saving medical supplies that are critically scarce across the country.

Shah is working to improve the situation by raising money to buy oxygen concentrators and other medical supplies to be sent to an organization called Gokuldham, which runs a COVID-19 hospital with a capacity for 100 people in a school building in opened in a rural area of ​​India. The hospital, Shah said, serves approximately 65 villages for a total population of more than 100,000 people.

“There isn’t even oxygen,” said Shah. “People can’t find oxygen tanks. So there is a humanitarian crisis in a nuclear-armed country that an Aspace shuttle can independently send to Mars, but cannot support, sustain, or direct a response to a one-off health crisis. This is (one of the) reasons why many faith and social organizations like Gokuldham are starting a COVID Care hospital and we are asking for outside help.

Shah collects donations of medicine, non-perishable food, and money from people to pay for supplies, which are collected by Swaminarayan Welfare Inc., a 501 (c) 3 nonprofit in New Jersey. Donations can be sent direct to 32 Benhardt Road, Mill Town, NJ, 08850 or Shah, 147 Black Thorn Drive, Jonesborough, TN, 37659.

Shah can also be reached by email at shahd@etsu.edu.

“Please help if you can,” pleaded Shah. “Any little help, you don’t understand how great it could be for someone who is unhappy and dies. Your life can be saved with just a few dollars. “

Three Florida Males Charged in $46 Million Well being Care Fraud, Kickback, and Cash Laundering Conspiracy | OPA

Three telemarketing company owners were charged with allegedly participating in a $ 47 million healthcare fraud, kickback and money laundering system that referred medically unnecessary cancer genetic tests to laboratories in exchange for kickbacks.

In an indictment unsealed today, Christian McKeon (35) and Athanasios Ziros (42) from Boca Raton (Florida) are charged with a conspiracy to commit health fraud, a conspiracy to pay and receive setbacks, and multiple charges of fraud. and backlash in healthcare, conspiracy to commit money laundering and the number of money laundering offenses. In a piece of information unsealed today, Gregory Orr, 64, is charged by Boca Raton with a conspiracy to pay and receive setbacks and a substantial number of setbacks for his alleged role in the system.

According to the indictment, McKeon and Ziros allegedly participated in a program to run a telemarketing campaign for Medicare beneficiaries to get them to accept cancer genetic testing, whether the tests were medically necessary or for a Medicare reimbursement Question came. Under the program, McKeon and Ziros telemedicine companies have allegedly offered and paid illegal kickbacks and bribes in exchange for medical instructions for expensive cancer genetic testing. Doctors’ instructions were written by doctors hired with telemedicine companies even though those telemedicine doctors had no prior relationship with beneficiaries, did not treat beneficiaries for cancer or cancer symptoms, and did not use the test results to treat beneficiaries and did not conduct a proper visit to telemedicine.

According to court records, all three men sold these signed cancer genetic testing medical instructions to laboratories in exchange for illegal setbacks. The charges and information state that the defendants caused one of the laboratories to file claims with Medicare for approximately $ 46 million, of which over $ 27 million was paid. The indictment also alleges that the lab paid McKeon, Ziros, and other setbacks totaling over $ 14 million, and that McKeon and Ziros laundered those unlawful receipts knowing that the transactions in question were intended to the manner, source and control of hiding and disguising the proceeds.

McKeon appeared before Judge William Matthewman of the US District Court for the South Florida District, West Palm Division, for the first time today. Ziros and Orr are expected to appear before Judge Matthewman on May 5th.

Charges of conspiracy to commit healthcare fraud and wire fraud, conspiracy to commit money laundering, and substantial money laundering each carry a maximum sentence of 20 years in prison. Charges of healthcare fraud and backlash violations each carry a maximum possible sentence of 10 years in prison. Eventually, the conspiracy to pay and receive setbacks carries a maximum penalty of five years in prison. A federal district judge determines each sentence based on U.S. sentencing guidelines and other legal factors.

Deputy Attorney General Nicholas L. McQuaid of the Department of Justice’s Department of Criminal Investigation; US Assistant Attorney Juan Antonio Gonzalez of the Southern District of Florida; Special Agent in Charge George L. Piro of the FBI Field Office in Miami; and special agent in charge Omar Perez of the US Department of Health (HHS), Inspector General’s Office (HHS-OIG), Miami, announced this.

Trial attorney Patrick Queenan of the Criminal Division’s fraud division is pursuing the case. U.S. Assistant Attorney Richard Brown from the Southern District of Florida is handling the decay aspect of the case.

The Fraud Section heads the Medicare Fraud Strike Force. Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 15 strike forces in 24 districts, has indicted more than 4,200 defendants who billed the Medicare program a total of nearly $ 19 billion. In addition, the HHS Centers for Medicare & Medicaid Services, in partnership with the HHS-OIG, are taking steps to increase accountability and reduce the presence of fraudulent providers.

Any physician or health care professional involved in suspected fraudulent telemedicine or genetic testing marketing programs should call to report this behavior to the FBI helpline at 1-800-CALL-FBI.

An indictment and information are just accusations, and all defendants are presumed innocent until found unequivocally guilty in a court of law.