Podcast

Alchemist Can’t Turn Outpatients Into Inpatients For Less Than $18.3 Million – Podcast

You know that I strongly believe that the future of hospitals isn’t hospitals, it’s outpatient facilities.

I’m not sure whether the folks at Banner Health read my book and (1) didn’t believe it, or (2) decided to prove me wrong, but either way it just cost them $18.3 million.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.weisspc.com

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Medical Group Minute | Videocast

Alchemist Can’t Turn Outpatients into Inpatients For Less Than $18.3 Million – Medical Group Minute Series

You know that I strongly believe that the future of hospitals isn’t hospitals, it’s outpatient facilities.
I’m not sure whether the folks at Banner Health read my book and (1) didn’t believe it, or (2) decided to prove me wrong, but either way it just cost them $18.3 million.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.weisspc.com

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Compliance

Alchemist Can’t Turn Outpatients Into Inpatients For Less Than $18.3 Million

As a frequent reader of the blog, you know that I strongly believe that the future of hospitals isn’t hospitals, it’s outpatient facilities. (In fact, if you haven’t already, grab a free copy of my 2016 book, The Impending Death of Hospitals, here.)

I’m not sure whether the folks at Banner Health read my book and (1) didn’t believe it, or (2) decided to prove me wrong, but either way it just cost them $18.3 million.

That’s the story revealed by the settlement earlier this month of a whistleblower case brought against Banner by Cecilia Guardiola.

Ms. Guardiola, a registered nurse, worked for Banner as its corporate director of clinical documentation back in 2012. She lasted three months before resigning over what she found to be improper charges to Medicare: billing short-stay, outpatient services that should have been performed on an outpatient basis as if they were more expensive inpatient services. She complained to other executives but they wouldn’t fix the problem.

Eventually, Ms. Guardiola found a pretty good gig as a whistleblower.

Her False Claims Act complaint lists the admission and discharge date/times on 679 cases, each a “zero day” case, many of which she alleged were billed as inpatient even though the patient was admitted to and discharged from the hospital on the same calendar day.

Her case just settled this month, with Banner paying $18.3 million to the government (but not admitting liability). Ms. Guardiola will receive around $3.3 million.

You might say that Ms. Guardiola had a banner day, but that Banner didn’t.

The fact of the matter is that every case that can be performed on an outpatient basis will be performed on an outpatient basis.

And, as Banner discovered, there’s a high price to pay for standing in the way of progress.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.weisspc.com

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Customer Service

How To Build A Whistleblower

When I was a kid, I built models, usually of airplanes and of cars.

Some hospitals and medical groups build whistleblowers.

I’m not kidding you.

These healthcare entities ignore employees or partners who come to the business or group with complaints related to billing irregularities, upcoding, lack of medical necessity, and so on. In doing so, they squander an opportunity to investigate and correct, and morph an early warning into an ignored insider who becomes determined to alert a “higher” authority.

Take the situation of Robert Kane:

Mr. Kane was assigned by his employer, Continuum Health Partners Inc., which operates the Healthfirst hospital network in New York, to investigate the amount of improper billings resulting from a computer glitch.

Kane completed his investigation and delivered a rough report indicating more than $1 million improperly billed. He informed his employer that further analysis was needed to confirm his initial findings.

Instead, he was fired. Then he blew the whistle by filing a False Claims Act lawsuit against Continuum.

View all compliance-related complaints as potentially valid. Investigate them. And make sure to let the person complaining know that you are taking the complaint seriously.

Will this completely prevent the employee or partner from becoming a whistleblower or from calling the feds? No. But it won’t be feeding upset until it turns into anger. And, it won’t be creating pretty good evidence that your group or business doesn’t care about compliance, magnifying the downside when the you-know-what hits the fan.

Building toy planes and cars was fun.

Building whistleblowers? Now so much fun at all.

Yet I can guaranty you that someone, somewhere is building one right now.

It’s not your group or facility, right?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.weisspc.com

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