‘Burdensome’: High Number Of Probes Into Health Care Fraud Cost Providers

Modern Healthcare looks at what’s behind a spike in investigations launched by prosecutors that sometimes seem to be fishing expeditions.

Modern Healthcare:
Healthcare Fraud Probes Grow In Number, Intensity

The possibility of scoring a lucrative healthcare fraud settlement may be spurring broad information requests by the government that look more like “fishing expeditions” than targeted investigations, and as a result are driving up providers’ costs, legal experts said. Healthcare fraud investigations have consistently netted the government more than $2 billion in settlements a year since 2010, with whistleblowers recouping hundreds of millions of that share annually, according to U.S. Justice Department data. A “historic” $6 billion healthcare fraud investigation unveiled last week will likely fuel more federal and state probes. (Kacik, 10/3)

Blue Cross NC, Wake Forest Baptist Form Another Health-Care Partnership

Blue Cross and Blue Shield of N.C. and Wake Forest Baptist Medical Center have formed their second health insurance network to serve the Triad. Blue Cross said it will offer, starting in January, what it is marketing as Blue High Performance network. The network provides members with access to a comprehensive set of doctors, hospitals and specialists, while lowering costs for employers. (Craver, 10/4)

Modern Healthcare:
New Jersey Hospitals Report ‘Historic’ Financial Impact From COVID-19

COVID-19’s financial impact on New Jersey hospitals has reached “historic levels,” with nearly 60% of providers reporting negative net margins throughout the first half of the year as a result of the pandemic. A mid-year snapshot of financial data released Friday by the New Jersey Hospital Association found providers statewide experienced significant declines in both patient volume and revenue compared to the same time last year. (Johnson, 10/2)

Boston Globe:
Hospitals Digging In For A Long Winter As Coronavirus Patients Increase 

The number of hospitalized coronavirus patients is steadily increasing across Massachusetts as health care leaders dig in for what they suspect will be a long winter of illness and unease. Since late August, when the number of hospitalized coronavirus patients across Massachusetts hit a low, the caseloads are up 41 percent, according to Sunday’s data from the state’s Department of Public Health. The steepest increases have come in the past two weeks. (Lazar, 10/4)

With An Anthropologist’s Eye, Duke Pioneers A New Approach To Medical AI

If not for an anthropologist and sociologist, the leaders of a prominent health innovation hub at Duke University would never have known that the clinical AI tool they had been using on hospital patients for two years was making life far more difficult for its nurses. The tool, which uses deep learning to determine the chances a hospital patient will develop sepsis, has had an overwhelmingly positive impact on patients. But the tool required that nurses present its results — in the form of a color-coded risk scorecard — to clinicians, including physicians they’d never worked with before. It disrupted the hospital’s traditional power hierarchy and workflow, rendering nurses uncomfortable and doctors defensive. (Brodwin, 10/5)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Source Article