Antitrust Concerns Rise With Hospital Acquisitions

The increase in activity of hospitals acquiring physician practices has peaked the interest of both state and federal antitrust regulators. Government agencies are launching investigations to ensure these consolidations are not being used by hospitals to boost healthcare prices. The U.S. Federal Trade Commission (FTC) has sought injunctions to stop hospital mergers and acquisitions three times in just the past twelve months!

The trend of physician practices being acquired by hospitals is being fueled by a federal push for Accountable Care Organizations (ACOs) and the offer of integrated care incentives.

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Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.

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Medicaid Fraud Program a Bust

A recent report from the Government Accountability Office (GAO) showed that the National Medicaid Audit Program cost taxpayers about $102 million since 2008, but realized under $20 million in overpayments. The report says that audits only identified overpayments 4 percent of the time. Peter Budetti, Deputy Administrator for the Centers for Medicare & Medicaid Services (CMS) says that CMS plans to redesign the program and has stopped conducting audits based on data in its federal Medicaid database that did not include names of hospitals or doctors and other essential information in detecting fraud. The National Medicaid Audit Program is expected to use state and federal data in a collaborative approach to identify areas of potential fraud, and the new approach used in 32 audits found more than $12 million in possible overpayments.

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Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.