Former HMA CEO to pay $3.5 million over false billing allegations

If big hospital systems are defrauding Medicare and the U.S. government, imagine what might be happening with employer health plans. Patients and employers need to beware of unnecessary procedures and inflated pricing. Medxoom’s proprietary comparison shopping technology can give employers and their employees the insights they need to help avoid inflated pricing and unnecessary billing.

From Los Angeles Times:

“The settlement comes about seven months after HMA agreed to pay the government¬†$262 million to settle related criminal charges and civil claims.

The government alleged Newsome caused HMA to pressure emergency department physicians to increase inpatient admissions by recommending admissions even when those patients could have been treated in less expensive outpatient or observation settings. Hospitals typically receive significantly higher payments from Medicare for inpatient admissions compared with outpatient treatment.

The Justice Department alleged Newsome caused HMA to pay EmCare, a company that provided physicians to staff HMA hospital emergency rooms, to recommend the unnecessary admissions. As part of that, the government said Newsome prompted HMA to pay EmCare’s physicians bonuses based on increased admissions of emergency department patients, with that metric tied to EmCare’s retention of existing contracts and receipt of new contracts.”

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