Jan 8, 2020

More hospitals in the crosshairs over patient referrals

Patient referrals are the lifeblood of hospitals. Photo: Andrew Lichtenstein/Corbis via Getty Images

New lawsuits allege that large hospital systems have illegally billed federal health care programs after making improper financial deals with doctors as a way to control where patients get care.

Why it matters: Hospitals that own physician practices capture more referrals and therefore more money than their competitors — but potentially skirt federal law and inflate the cost of care for everyone in the process.

Driving the news: The former CFO of Community Health Network, a hospital system in Indiana, alleged the system employed physicians with "excessive" salaries well above fair market rates as a way to secure those physicians' referrals, and then bill higher rates for hospital services.

  • The Justice Department intervened in the case, which often means the feds believe the case has merit. CHN released a statement saying this was a "waste of the government's time and resources to pursue these meritless claims."
  • Read the full complaint.

Separately, an orthopedic surgeon in Florida alleged in a newly unsealed whistleblower case that Orlando Health pressured doctors to conduct surgeries and imaging tests only at facilities owned by Orlando Health. He says he was fired because he was still seeing patients at competing hospitals.

  • The Justice Department declined to intervene in the case for now. Orlando Health said it does not comment on pending litigation.
  • Read the full complaint.

Go deeper: "The hidden system that explains how your doctor makes referrals," via the Wall Street Journal.

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Hospitals' dueling financial realities

Illustration: Sarah Grillo/Axios

As hospital prices rise and much of the sector continues to rake in cash, rural hospitals continue to shutter.

Why it matters: There's no way to address U.S. health care spending without cutting hospital costs. But blanket cuts could hurt hospitals that are already struggling to keep their doors open, leaving vulnerable patients without access to care.

Go deeperArrowJan 13, 2020

Some doctors are profiting from patients' personal-injury lawsuits

Some doctors are treating patients and then waiting to be paid through those patients' personal-injury lawsuits, which can be much more lucrative than billing through insurance, the Wall Street Journal reports.

Between the lines: These "lien doctors" have been around for years, but recent legal and policy changes have led to the practice becoming more common, including in California, Florida, Colorado, Texas and Georgia.

Go deeperArrowJan 9, 2020

Military hospitals are aggressively going after medical debt

Illustration: Sarah Grillo/Axios

Add the U.S. government to the list of groups going after patients for thousands of dollars in medical debt, per reporting by The Center for Public Integrity and The Atlantic.

How it works: Civilians can receive care at military hospitals in an emergency or if the military hospital offers superior care.

Go deeperArrowJan 22, 2020