CMS physician fee updates, inpatient-only list proposals, billions of dollars in deals and more: Here are 13 of the biggest stories in July:
1. New Port Richey, Fla.-based pain management practice Paragon Community Healthcare was ordered to permanently close as part of a settlement over alleged Controlled Substances Act violations. The clinic's owners and one of its former physicians will collectively pay $600,000 as part of the settlement.
2. Dallas-based Tenet Healthcare now owns 100 percent of United Surgical Partners International's voting shares, CEO Saum Sutaria, MD, said during a July 22 earnings call. The ASC market is expected to be Tenet's primary growth driver in the coming years. Dr. Sutaria said Tenet has about a 7 percent share of the ASC market. Tenet expects to have 575 to 600 ASCs by the end of 2025.
3. A fired Indiana physician is suing her former employer, Lebanon, Ind.-based Witham Memorial Hospital, alleging she was illegally discriminated against after becoming ill due to dangerous office conditions. Kimberly Gatzimos, MD, was employed at the hospital from 2000 until her Jan. 21 termination.
4. Amazon's plan to acquire primary care provider company One Medical could raise costs for all medical groups and further alter the dynamics of physician recruiting and acquisitions. Independent physicians should be prepared for "an entirely new dynamic" when it comes to prospective buyers. The new market will include unconventional buyers, such as larger retail companies, and there will be a bigger push toward consolidation as more buyers look to buy physician practices.
5. An ENT is suing Houston Methodist Hospital for $25 million, alleging the hospital defamed her for expressing her opinion on vaccine mandates. Mary Bowden, MD, who runs her own private practice and has privileges at the hospital, said it damaged her reputation and published defamatory statements to media about her after she posted on Twitter that she felt vaccination mandates are wrong.
6. The post-surgery process often involves some physical pain, but the related mental effects tend to be treated as an afterthought, if not overlooked entirely. The PREOP Center, based in San Antonio, is aiming to change that. Clinicians at PREOP, which stands for Patient Risk Evaluation and Optimization Program, evaluate patients before surgery, identify factors that may impact recovery, and create a post-op pain plan for each patient.
7. Optum's $300 million purchase of Healthcare Associates of Texas, a Dallas-based physician practice management company, brings Optum's acquisition deal total this year to nearly $8 billion. Healthcare Associates of Texas offers family medicine, physical therapy, sleep medicine, a wellness clinic, pharmacy and lab and imaging services.
8. An Easton, Pa., man has sued his physician, Ajeeb John Titus, MD, alleging he overprescribed him opioids that led to his addiction. The patient, Carl Graves, accuses Dr. Titus in the suit of prescribing at least 7,400 oxycodone pills and 1,700 amphetamine pills over a four-year period without administering diagnostic tests. Mr. Graves lost his supply of painkillers when Dr. Titus was arrested in 2020, and Mr. Graves wound up in the hospital several times.
9. Medicare is recommending removing 10 procedures from the inpatient-only list in 2023, according to its Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed rule, released July 15.
10. Mathew James, CEO of medical billing company Leal, was convicted over a $600 million fraud and identity theft scheme. Mr. James, 54, billed payers for surgeries with higher reimbursement rates than the procedures his physician-clients actually performed. If a payer denied one of the inflated claims, Mr. James would impersonate the patient and demand the payer cover the outstanding balance of tens or hundreds of thousands of dollars.
11. A federal judge rejected the University of Pittsburgh Medical Center's bid to dismiss a whistleblower lawsuit against UPMC, its physicians group and its chair of cardiothoracic surgery. The Justice Department alleges UPMC and James Luketich, MD, chair of cardiothoracic surgery at the medical center, "regularly sacrificed patient health in order to increase surgical volume" and "maximize profit."
12. CMS has released its Medicare physician fee schedule proposed rule for 2023, which suggests further cuts to physician pay while inflation and the cost of running an independent practice continue to rise. The rule would decrease the conversion factor by $1.53 to $33.08, representing a 4.42 percent drop. The current conversion factor is $34.61.
13. After awaiting trial in jail without bond for 43 months, Detroit physician Rajendra Bothra, MD, was acquitted June 29 of all charges that he used his pain clinics to illegally prescribe $500 million in opiods. An interventional pain physician, Dr. Bothra was accused of heading an opioid scheme from his three clinics in Michigan — The Pain Center USA in Warren and Eastpointe and Interventional Pain Center in Warren.