The Trump administration has despatched lots of of thousands and thousands of in pandemic-related bailouts to well being care suppliers with checkered histories, together with a Florida-based most cancers heart that agreed to pay a $100 million prison penalty as a part of a federal antitrust investigation.
At least half of the highest 10 recipients, a part of a gaggle that obtained $20 billion in emergency funding from the Department of Health and Human Services, have paid thousands and thousands in recent times both in prison penalties or to settle allegations associated to improper billing and different practices, a Kaiser Health News evaluate of presidency information exhibits.
They embrace Florida Cancer Specialists & Research Institute, one of many nation’s largest U.S. oncology practices, which in late April mentioned it could pay a $100 million penalty for partaking in an almost two-decade-long antitrust scheme to suppress competitors. A prime Justice Department lawyer described the plot as “limiting treatment options available to cancer patients in order to line their pockets.” The firm, which is required to pay the primary $40 million in penalties by June 1, obtained greater than $67 million in HHS bailout funds.
HHS distributed emergency funding to hospitals and different suppliers to assist offset income losses or bills associated to COVID-19. In April, it distributed the primary $50 billion primarily based on suppliers’ web affected person income, a calculation that offers extra money to larger programs or establishments charging larger costs.
Companies which have attested to receiving funds as of May four collectively obtained roughly $20 billion. The listing is prone to change within the coming days as different firms affirm they’ve obtained cash.
In whole, the CARES Act, signed into legislation by President Donald Trump in March, gives $100 billion in emergency funding. Subsequent coronavirus aid laws added one other $75 billion. Money has additionally been steered to sizzling spots with excessive numbers of COVID-19 sufferers, rural well being care suppliers and the Indian Health Service.
Of the businesses documented thus far, different prime recipients ― together with Dignity Health in Phoenix, the Cleveland Clinic, Houston’s Memorial Hermann Health System and Massachusetts General Hospital in Boston — have paid thousands and thousands in recent times to resolve allegations associated to improper billing in federal well being packages, false claims to extend their funds or lax oversight that enabled staff to steal prescription painkillers.
Dignity Health, one of many largest hospital programs within the West, obtained $180.three million in HHS bailout funds, making it the highest recipient listed. It has settled civil accusations by DOJ that it submitted false claims to Medicare and TriCare, the army well being care program.
The Cleveland Clinic, which in 2015 paid $1.74 million to settle federal allegations that it mischarged Medicare for expensive spinal procedures to extend their billings and has entered into different related settlements, obtained $103.three million from HHS, the second-largest quantity.
Memorial Hermann Health System and Massachusetts General Hospital obtained greater than $93 million and $58 million, respectively. In 2018, Memorial Hermann paid practically $2 million to the federal government to settle allegations that it improperly billed authorities well being care packages by charging for higher-cost companies when sufferers solely wanted lower-cost outpatient companies.
Massachusetts General Hospital in 2015 paid the federal authorities $2.three million to settle allegations that lax oversight enabled hospital staff to steal 1000’s of prescription drugs, principally addictive painkillers, for private use.
Malcolm Sparrow, a professor on the Harvard John F. Kennedy School of Government, mentioned the HHS methodology for its common distribution of aid funds is “a little bit worrying.”
“If you peg the amount based on historical volume and you’ve got good reason to believe that historical volume is inflated due to fraud and abuse, the irony is that they get more money because they’re more dishonest,” Sparrow mentioned. “But you can’t prove that in a short period of time.”
Public tolerance for fraud and abuse naturally rises throughout instances of emergency, Sparrow mentioned, and now isn’t the time to revisit historic choices to find out which firms are entitled to federal aid primarily based on authorized points.
“I think that’s a tough case to make,” he mentioned.
HHS has criteria for disqualifying providers from receiving bailout cash. But even the strongest situation carries a broad caveat: None of the funds could also be used for grants to any company convicted of a felony prison violation inside the previous two years ― except officers have determined that it’s not crucial to ban them from doing enterprise with the federal authorities.
“It’s sort of a high bar” for somebody to be disqualified for this cash, mentioned Roger Cohen, a well being care lawyer at Goodwin who makes a speciality of fraud and anti-kickback legislation.
The Florida oncology supplier has been charged with a felony and admitted to an antitrust crime, nonetheless federal prosecutors agreed to defer any prosecution and trial as a result of a prison conviction would have “significant collateral consequences” for its sufferers, the DOJ mentioned.
Beyond that, HHS in its phrases states that suppliers must certify that they aren’t excluded from collaborating in federal well being care packages like Medicare and Medicaid and haven’t had their Medicare billing privileges revoked.
The HHS Inspector General has the authority to exclude practitioners and well being care firms for all kinds of causes — together with a conviction of fraud ― however it’s extremely uncommon for the federal authorities to take action with giant establishments, specialists say.
“I imagine there would be hesitancy to exclude the provider,” Cohen mentioned. “I think you’d have concerns about interrupting access to care.”
An HHS spokesperson declined to touch upon its present allocations however mentioned the division has guidelines in place to recoup funds and handle fraudulent exercise if crucial.
“Failure to comply with any term or condition is grounds for HHS to recoup some or all of the payment from the provider,” the spokesperson mentioned.
In an announcement, Florida Cancer Specialists signaled it supposed to make use of the funding.
“During this health crisis, we have continued to keep the doors of our more than 80 facilities open to ensure that cancer patients have access to care and treatment,” Thomas Clark, the corporate’s chief authorized officer, wrote in an electronic mail. “We plan to use these funds, if needed, in accordance with government guidelines to continue providing affordable, safe and high-quality cancer care.”
Dignity Health mentioned, “We have had to bear significant costs to prepare for and manage the pandemic in our communities even as patient volumes have been dramatically reduced across our hospitals.”
In October 2014, Dignity agreed to pay $37 million after the Department of Justice alleged it admitted sufferers to 13 of its hospitals in California, Nevada and Arizona who may have been handled on a “less costly, outpatient basis.” The civil case concerned sufferers handled for elective coronary heart procedures, resembling pacemakers and stents, and different circumstances. The firm didn’t acknowledge wrongdoing in settling the case.
“Charging the government for higher-cost inpatient services that patients do not need wastes the country’s vital health care dollars,” appearing Assistant Attorney General Joyce Branda for the Justice Department’s Civil Division mentioned on the time. “This department will continue its work to stop abuses of the nation’s health care resources and to ensure patients receive the most appropriate care.”
Dignity mentioned that impartial annual audits have been carried out after the False Claims Act settlement in 2014 and “no additional concerns were raised related to this issue.”
Massachusetts General Hospital and Memorial Hermann didn’t reply to requests for remark. The Cleveland Clinic confirmed the amount of cash obtained from HHS however declined to remark additional.