32 Hospitals to Pay U.S. to Resolve False Billing Claims

Thirty-two hospitals located throughout 15 states have agreed to pay the United States a total of more than $28 million to settle allegations that the health care facilities submitted false claims to Medicare for minimally-invasive kyphoplasty procedures, the Justice Department announced today.  The Justice Department has now reached settlements with more than 130 hospitals totaling approximately $105 million to resolve allegations that they mischarged Medicare for kyphoplasty procedures. 

Kyphoplasty is a minimally-invasive procedure used to treat certain spinal fractures that often are due to osteoporosis.  In many cases, the procedure can be performed safely and effectively as an outpatient procedure without any need for a more costly inpatient hospital admission.  The settlements announced today resolve allegations that the 32 settling hospitals frequently billed Medicare for kyphoplasty procedures on a more costly inpatient basis, rather than an outpatient basis, in order to increase their Medicare billings.

“Charging the government for higher cost inpatient services that patients do not need wastes the country’s vital health care dollars,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division.  “The Department of Justice is committed to ensuring that Medicare funds are expended appropriately, based on the medical needs of patients rather than the desire to maximize hospital profits.”

The settling facilities and the amounts they have agreed to pay, include the following: 

  • The Cleveland Clinic in Cleveland, Ohio, has agreed to pay $1.74 million.
  • Citrus Memorial Health System in Inverness, Florida, has agreed to pay $2.6 million.
  • Cullman Regional Medical Center in Cullman, Alabama, has agreed to pay $350,000.
  • Martin Memorial Medical Center in Stuart, Florida, has agreed to pay $2 million.
  • MultiCare Tacoma General Hospital in Tacoma, Washington, has agreed to pay $983,000.
  • Norwalk Hospital in Norwalk, Connecticut, has agreed to pay $920,000.
  • Princeton Community Hospital Association in Princeton, West Virginia, has agreed to pay $1,513,500.
  • Sacred Heart Medical Center in Spokane, Washington, has agreed to pay $906,000.
  • Sarasota Memorial Hospital in Sarasota, Florida, has agreed to pay $972,000.
  • Spartanburg Regional Health Services District Inc. in Spartanburg, South Carolina, has agreed to pay $1.725 million.
  • St. Cloud Hospital in St. Cloud, Minnesota, has agreed to pay $500,000.
  • Tampa General Hospital in Tampa, Florida, has agreed to pay $2 million.
  • Five hospitals affiliated with Community Health Systems Inc., in Franklin, Tennessee, have agreed to pay a total of $3.5 million.These include:Crestwood Medical Center in Huntsville, Alabama; St. Joseph’s Hospital in Fort Wayne, Indiana; Carolinas Hospital System in Florence, South Carolina; Mary Black Health System in Spartanburg, South Carolina; and Trinity Medical Center in Birmingham, Alabama.
  • Five hospitals affiliated with Tenet Health Care Corporation in Dallas, Texas, have agreed to pay a total of $2.2 million. These include:East Cooper Medical Center in Mt. Pleasant, South Carolina; North Fulton Hospital in Roswell, Georgia; Providence Memorial Hospital in El Paso, Texas; St. Francis Hospital in Memphis, Tennessee; and Sierra Medical Center in El Paso.
  • Five hospitals formerly owned and operated by Health Management Associates Inc., in Naples, Florida, have agreed to pay a total of $2 million.These include:Biloxi Regional Medical Center in Biloxi, Mississippi; Davis Regional Medical Center in Statesville, North Carolina; Lancaster Regional Medical Center in Lancaster, Pennsylvania; Physicians Regional Medical Center in Naples, Florida; and Riley Hospital in Meridian, Mississippi.
  • Three hospitals affiliated with BayCare Health System in Clearwater, Florida, have agreed to pay a total of $1.5 million.These include:Winter Haven Hospital in Winter Haven, Florida; St. Joseph’s Hospital in Tampa, Florida; and St. Anthony’s Hospital in St. Petersburg, Florida.
  • Two hospitals affiliated with Banner Health in Phoenix, Arizona, have agreed to pay a total of $2.685 million.These include Banner Boswell Medical Center in Sun City, Arizona, and Banner Thunderbird Medical Center in Glendale, Arizona.

“As has been shown throughout this successful investigation, we will never allow hospitals to put profits ahead of patients,” said U.S. Attorney William J. Hochul Jr. of the Western District of New York. “Decisions regarding potential procedures should be made using sound medical judgment only, not with an eye toward increasing Medicare reimbursements. The public should be assured that any hospital involved in improper kyphoplasty billing will be held accountable for its actions.”      

In addition to settlements with over 130 hospitals, the government previously settled with Medtronic Spine LLC, the corporate successor to Kyphon Inc., for $75 million to settle allegations that the company caused false claims to be submitted to Medicare by counseling hospital providers to perform kyphoplasty procedures as inpatient rather than outpatient procedures.       

All but three of the settling facilities announced today were named as defendants in a qui tam, or whistleblower, lawsuit brought under the False Claims Act, which permits private citizens to bring lawsuits on behalf of the United States and receive a portion of the proceeds of any settlement or judgment awarded against a defendant.  The lawsuit was filed in federal district court in Buffalo, New York, by Craig Patrick and Charles Bates.  Patrick is a former reimbursement manager for Kyphon, and Bates was formerly a regional sales manager for Kyphon in Birmingham.  The whistleblowers will receive a total of approximately $4.75 million from the settlements announced today. 

This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services.  The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation.  One of the most powerful tools in this effort is the False Claims Act.  Since January 2009, the Justice Department has recovered a total of more than $26.7 billion through False Claims Act cases, with more than $16.8 billion of that amount recovered in cases involving fraud against federal health care programs.

The settlements were the result of a coordinated effort among the U.S. Attorney’s Office for the Western District of New York, the Civil Division’s Commercial Litigation Branch and the Department of Health and Human Services’ Office of Inspector General and Office of Counsel to the Inspector General.

The claims resolved by these settlements are allegations only, and there have been no determinations of liability. 

Nurses Speak Out at Cal/OSHA Public Hearing: Urge Speedy Passage of Violence Prevention Regulations

A quick look at The Women’s Global Health Leadership Certificate Program

A quick look at the Women’s Global Health Leadership Certificate Program with recent course graduate RN Jana Sui and NNU Education Director Michelle Grisat.

RN Jana Sui, a recent graduate of the “Women’s Global Health Leadership Certificate Program shares why she was drawn to the course and the impact she knows it will have in the world. National Nurses United Educational Director, Michelle Grisat provides an overview of the certificate program.

Nurses join with partner environmental groups to demand climate justice now

            More than 1,200 California Nurses Association/National Nurses Organizing Committee registered nurses, environmental and healthcare activists, and students on Dec. 3 marched and rallied in Los Angeles to demand that the world’s leaders, now convening in Paris for the United Nations Conference on Climate Change, adopt a binding and enforceable climate treaty, commit resources to fund the transformation to clean, renewable energy including a just transition program for those who now work in the fossil fuel industry, and call on wealthy, developed countries to provide resources for the less-developed countries to act on climate, with funding coming from a carbon tax and the Robin Hood tax.

            “I’m a registered nurse and our planet is my patient, and it is on life support,” said Malinda Markowitz, RN and a CNA/NNOC copresident and vice-president of National Nurses United, to the crowd assembled in downtown Los Angeles’ Pershing Square. “As nurses, we see the health consequences from the effects of pollution created by fossil fuels. We deal with the human fallout of climate injustice. Enough is enough. As nurses we know we must respond by giving care and by protest, protest, protest! We will never stop protesting.”

Nurses drop banner off freeway overpass during climate march

 

            In a march leading up to the rally, nurses chanted “No more Chevron, No BP! Energy democracy!” and “Hey hey! Ho ho! Fossil fuel has got to go!” As they crossed the 110 freeway, they dropped a banner from the overpass that read, “Last exit ahead. Climate action now!” to underscore how dire the crisis has become.

            The public health dimensions of the global climate crisis are extensive and far-reaching, nurses say. According to the World Health Organization, more than 8 million deaths worldwide are directly attributable to air pollution, primarily from the burning of fossil fuels and lack of access to clean energy. Infectious and vector-born diseases, such as malaria, dengue, yellow fever, and Lyme, will spike as temperatures increase. Further global warming and climate change will magnify the already catastrophic health impacts of: fossil fuel pollution, hunger and malnutrition due to desertification and devastation and displacement from severe weather events and sea level rise.

            Many speakers from different sectors of the movement for climate justice addressed the crowd and shared testimonials. Dr. Paul Song, an oncologist and executive chairman of the Courage Campaign, got to the bottom line when he said, “I really come before you today less as a doctor and more as a father of a 3-year-old girl, who has such a bright future ahead of her assuming that the planet stays okay. But the sad fact is that she is already experiencing effects of global warming firsthand that could very well affect her health for years to come.”

            And Rachel Hernandez-Brown, a pediatric RN in Bakersfield which, as a city in California’s Central Valley, experiences some of the worst air pollution in the state, shared her stories and thoughts about how fossil fuel pollution harms her young patients. She constantly sees children coming in who struggle to breath and suffer from respiratory distress. “I leave my shift knowing, as I walk outside, ‘This is the air quality this baby was born in. This is the air quality that this child’s lungs will develop into as an adult. This is the air quality that this adult will have to work in day after day. This is the air quality that this elderly person will eventually succumb to and die from,  prematurely. This is the air quality that fracking is causing for our community. We need to do something. My community deserves clean air and clean water just like everywhere else. My community needs a climate change now.”

            Nurses received many kudos from the attending environmental advocacy organizations for taking such a strong, prominent position against climate change and were recognized as frontline responders to the human health effects of climate change and environmental pollution. “We are happy to stand with you again and again because you are the climate warriors in the labor movement that this planet needs,” said Walker Foley, an organizer with Food and Water Watch and Californians Against Fracking.

Executive Director RoseAnn DeMoro marched with Council of Presidents, leading hundreds of nurses through the streets of LA

 

            Nurses were joined by doctors in sounding the alarm about the health hazards of climate change. “Climate change is a public health emergency,” said Dr. Devki Patel, a pathologist with Physicians for Social Responsibility who went on to talk about performing an autopsy a few years ago on a 45-year-old man who had died from an asthma attack. “His lungs were filled with thick mucous. That day, I realized how deadly asthma can be. I must speak out for stronger regulation of air pollution.”

            Many of the advocates pointed out that the effects of climate change and environmental pollution do not affect all people equally, but are especially harmful to low-income people and communities of color who tend to live closer to ports, refineries, oil and fracking wells, and other fossil fuel extraction and processing sites. “I’m Ashley from Wilmington,” said Ashley Hernandez, a representative from Communities for a Better Environment but also a resident of an ethnically diverse and lower-income Southern California city with a disproportionately high density of oil wells. “I’m here to represent a lot of members from my community that are living within a couple of feet from industries that are burning fossil fuels, where they are extracting fuel from our communities. That is an environmental injustice and something we should not stand for.”

            Everybody spoke about holding our local, state, national, and world elected officials accountable and for passing and enforcing laws, policies, and regulations that will help reverse climate change. One such avenue is by lobbying our governments to move public funds our of investments in fossil fuel industries and corporations, in a movement termed “divestment.” Former California legislator Tom Hayden pointed out that divestment works and gave the shift away from investment in the coal industry within California as an example. “It’s being phased out, it’s history,” said Hayden. “And there’s more to come. Now the laws should be aimed at oil and natural gas. Wherever there are shareholder risks and health risks from climate catastrophes, the divestment movement will come. The message should be to divest from fossil fuels, but also to constructively invest in the positive future of clean, renewable energy.”  

Nurses for Bernie community party in Fremont, CA.

Over the past few months, in living rooms & community centers across the country, nurses have been gathering to host parties in support of Bernie Sanders. Nationwide we’ve been coming together to talk about Bernie’s candidacy and brainstorm ways we can help. This past weekend, around 150 nurses and community members came together for a Nurses For Bernie Community Party in Fremont, CA. 

During the event, nurses spoke about the many reasons Nurses support Bernie – Robin Hood Tax, Free College, Medicare for All, Climate Change leadership, a Pro-Peace foreign policy & more.

 

Nurses also did en masse Zumba, held a raffle offering items contributed by the community, had a pot luck featuring food that reflected the diversity of Fremont, hosted a kids dance contest, and more. 

 

Through the raffle and independent donations, nurses raised over $1300 for the Bernie campaign!

 

The event was highlighted by a supporter who ran 30 miles from Berkeley to the event in Fremont, wearing a cape that read “Feel The Bern. Bernie 2016.” 

 

This event was an absolute success. The sense of community and widespread desire for fundamental social and economic change was strong and palpable. Fremont is Feeling the Bern!

 

 

 

 

Apply now! Scholarships for NNU’s Women’s Global Health Leadership classes.

As part of the Certificate Program in Women’s Global Health Leadership, we are pleased to announce the following Spring 2016 courses co-sponsored by National Nurses United and Rutgers, The State University of New Jersey:

  • Impacts of Economic Inequality on Women’s Health;
  • The Growth Imperative, Global Ecology, and Women’s Health; and
  • Health Consequences of the Global Trade in Pharmaceuticals.

The courses will be offered online during the Spring Semester of 2016.  Classes begin January 19, 2016.

Full-tuition scholarships are available for NNU members interested in building global solidarity with those who share RN values of caring, compassion, and community.  To apply for a full-tuition scholarship for a course, please submit a short essay (250 to 500 words) describing how the topic of the course will inform your RN patient advocacy.  NNU members may apply for a scholarship for more than one course.  A separate essay is required for each course for which an RN seeks a scholarship.

All interested scholarship applicants should submit their essay via email to WGHL@nationalnursesunited.org with the subject line “Scholarship” no later than December 4, 2015.  Applicants also need to complete and submit this scholarship cover sheet with their essay. 

If you have any questions, please contact the Certificate Program Administrative Coordinator, Randi Pace, at (510) 433–2793 or WGHL@nationalnursesunited.org

This certificate program is of vital importance for nurses as it is the only academic program in the country that honestly assesses the rapidly changing socioeconomic landscape of healthcare in the United States and globally from the standpoint of bedside RNs.  Classes prepare nurses to identify and confront social, economic, political, and environmental forces that place their jobs, livelihoods, communities, and planet in jeopardy. 

Click here to read more about the certificate program.

Class Descriptions:

The Growth Imperative, Global Ecology, and Women’s Health

In the last quarter century, the premise of the possibility of endless growth for the purpose of unlimited capital accumulation has met the inevitable challenges of resource exhaustion on a global scale and its human consequences. Markets and technological innovation are inadequate to solve the resulting environmental crises. Health consequences include illness caused by toxic industrial byproducts, injury from resource extraction processes such as nuclear fission and deep–water oil drilling, manifold health hazards of violent conflict over control of scarce resources in postcolonial states, and dangers that attend climate change. This course will address externalized business costs paid in the currency of human health.

Health Consequences of the Global Trade in Pharmaceuticals

This course explores the political economy of the global pharmaceutical industry. Students will examine ethical issues such as: disproportionate investment in drugs for minor health problems while serious diseases affecting the poor and other marginalized groups remain insufficiently studied; inadequate vaccine development and manufacture; restrictions on the distribution of life-saving generic drugs in third world countries; overuse of antibiotics and the emergence of antibiotic resistant bacteria; and the role of the pharmaceutical lobby influencing healthcare.

Impacts of Economic Inequality on Women’s Health

Domestic and global economic inequality place significant numbers of people at high risk for health crises even as they are denied access to care. This course investigates the “pathogenic” aspects of economic inequality. It examines how systems of unequal resource distribution contribute to wide disparities of health risk, access to healthcare, and clinical outcomes. In addition, the affects of global trade and transnational migration on health costs, healthcare delivery systems, and the availability of healthcare professionals are explored. By tracing links between macro-economic policies and access to healthcare, the course analyzes pathologies suffered in the context of structural violence.”

In Solidarity,

National Nurses United

Hundreds of Nurses Join Million Student March