Medicare Compliance & Reimbursement
DOJ Says WV Hospitals Too Close For Comfort
Why being bosom buddies with another facility is unlikely to result in good times. The DOJ's Antitrust Division filed a lawsuit March 21, charging the hospitals' agreements as violating Section 1 of the Sherman Act.
Hospitals should tread carefully when making agreements with other facilities, or they might land on the Department of Justice's (DOJ) choppiing block.
Here's why: The DOJ recently ended an "illegal" patient-swapping agreement between two West Virginia hospitals, Bluefield Regional Medical Center, Inc. (BRMC) and Princeton Community Hospital Association, Inc. (PCH), according to a department press release.
Struck on Jan. 30, 2003, the agreement called for BRMC to offer its cancer treatment services to PCH, and in return, PCH would offer its cardiac surgery services to BRMC.
Though BRMC and PCH were once competitors, the two hospitals closed the market to other area hospitals on cancer and cardiac care services by contracting with each other exclusively. BRMC and PCH requested a joint certificate of need (CON), a permit that expresses the necessity of the agreements between the hospitals by reporting an unmet need for the facilities' services in a given region.
"The Sherman Act clearly prohibits hospitals and other competitors from engaging in this type of market allocation schemes," says J. Bruce McDonald, the DOJ's Antitrust Division's Deputy assistant attorney general.
Despite the CON, the DOJ found the pact nixed fair competition and was a detriment to consumers.
Furthermore, the justice department prohibited BRMC and PCH from entering into and cancer- or cardiac surgery-related agreements without first gaining federal approval.
Lesson Learned: A CON won't always protect a hospital from federal antitrust reviews.
To read the DOJ's press release, go to www.usdoj.gov/opa/pr/2005/March/05_at_135.htm.
Medicare Compliance & Reimbursement
- PHARMACEUTICALS:
Medicare Slashes Drugs By Up To 60 Percent
But some drugs may actually get a payment bump.
Any providers pining for Medicare payments for [...] - PHYSICIANS:
Show Septis, Then Bill For Septic Shock
Clarifications, not new codes, highlight ICD-9 changes.
If you're a physician treating a patient with septic [...] - MEDICARE:
CMS Studying Increase In Physician Spending On Part B Premiums
Intense office visits a cause for increase.
Unfortunately for beneficiaries, it appears there is no end [...] - COVERAGE:
LOCM Get New Code Set
CMS unveiled Q codes in March.
Providers who routinely bill for low osmolar contrast material (LOCM) [...] - HOME HEALTH:
CPO Change Provides Good Marketing Ammo
Contact docs now to let them in on a new way to make money.
It's final: [...] - MEDICARE:
Rising Costs Will Eventually Price Beneficiaries Out
It's unavoidable, as health-care costs rise faster than U.S. earnings.
Over the long term, both the [...] - MEDICAID:
What's Up For Medicaid When Congress Returns?
Good question: Here's what a couple insiders had to say.
As Congress adjourned for its spring [...] - COVERAGE:
Big Change Coming In Medicare Payments - COMPLIANCE:
CMS Issues Its First Draft Of NCD
Increased access to CMS staff a priority.
The Centers for Medicare and Medicaid Services has unveiled [...] - ENFORCEMENT WATCH:
DOJ Says WV Hospitals Too Close For Comfort
Why being bosom buddies with another facility is unlikely to result in good times.
Hospitals should [...] - MEDICARE MODERNIZATION ACT:
SPAPs Can Still Coordinate Aid With Medicare Benefit
But the SPAP must be 'qualified' to be kosher.
Those unanswered questions on the Medicare Modernization [...] - PHYSICIANS:
CoP Out Or Compassion? CMS Wants To Rein In Regs
Proposed rule will allow docs to focus more time on patients.
If you're a physician who [...]
