News From Around the Industry

BlueCross BlueShieldUncategorized

We’ve shared insight into how we’re navigating our current situation with CHI Memorial. Below are sources from around the healthcare industry with more information on CommonSpirit, parent company of CHI Memorial.

Reports of Financial Mismanagement

CommonSpirit Keeps Growing, and Losing Money, StatNews, 9/25/23

“The system of more than 140 hospitals has lost money almost every year since it was formed through a 2019 mega-merger. At the same time, it keeps adding more hospitals — and with them, more debt.”

CommonSpirit’s answer to losing money: get bigger, StatNews, 9/25/23

“A deeper look at CommonSpirit’s wider system reveals broader financial mismanagement. CommonSpirit’s reckless spending and acquisition spree has led to massive losses year after year, until recently ending the fiscal second quarter of 2023 with an added $1.1 billion.”

How a Sprawling Hospital Chain Ignited Its Own Staffing Crisis, New York Times, 12/16/22

“At a Washington State hospital that is part of CommonSpirit Health, another giant nonprofit chain, years of belt-tightening reached a breaking point in October when an overwhelmed nurse called 911 dispatchers, who sent the fire department to help care for patients.”

CommonSpirit kicks off 2024 fiscal year with $738M loss, HealthcareDive, 11/16/23

“The eye toward expansion comes even as the operator reported it is “actively monitoring” its liquidity amid “weak” operating cash flows and investment losses.”

Reports of Medicare Fraud

Cashing in on COVID-19 billions despite Medicare fraud, millions in settlements, Chicago Sun-Times, 7/10/20

“Chicago-based hospital giant CommonSpirit Health got $1.9B in federal loans, $718M in grants. That was after paying $80M over a decade for federal violations.”

Dignity Health pays $10 million to settle fraud allegations, ModernHealthcare, 5/7/21

“[CommonSpirit entity] Dignity Health and its medical group Neurosurgical Associates agreed to pay $10 million to settle allegations that it defrauded Medicare. Phoenix-based St. Joseph’s Hospital, which is operated by Dignity’s neurosurgeons, allegedly performed concurrent surgeries even though it billed Medicare for separate procedures.”

Three health care providers agree to pay $22.5 million for alleged false claims to California’s Medicaid program, Department of Justice, 12/7/22

“[CommonSpirit entity] Dignity Health (Dignity), a not-for-profit health system…agreed to pay a total of $22.5 million pursuant to two separate settlements to resolve allegations that they violated the federal False Claims Act and the California False Claims Act by causing the submission of false claims to Medi-Cal related to Medicaid Adult Expansion under the Patient Protection and Affordable Care Act (ACA).”

California County Organized Health System and Three Health Care Providers Agree to Pay $70.7 Million for Alleged False Claims to California’s Medicaid Program, Department of Justice, 8/18/22

“Gold Coast Health Plan, a county-organized health system in California and three of its providers, Ventura County, Dignity Health, and Clinicas Del Camino Real, Inc., paid a combined total of $70.7 million to resolve claims that they knowingly submitted or caused the submission of false claims to California’s Medicaid program in connection with the “Adult Expansion” population that was created by the Patient Protection and Affordable Care Act.”

Dignity Health Agrees to Pay $37 Million to Settle False Claims Act Allegations, Department of Justice, 10/30/14

“[CommonSpirit entity] Dignity Health has agreed to pay the United States $37 million to settle allegations that 13 of its hospitals in California, Nevada and Arizona knowingly submitted false claims to Medicare and TRICARE by admitting patients who could have been treated on a less costly, outpatient basis.”

Negotiations

Patients caught in crossfire between giant hospital chain, large insurer, Fierce Healthcare, 2/6/20

“Melnick believes Dignity is using an “all or nothing” strategy in contract negotiations, meaning either all its facilities are in the insurer’s network or none are.

‘This allows them to increase their market power to get higher prices, which is not necessarily good for consumers,’ Melnick said.”

CommonSpirit Health terminating services at Blue Cross and Blue Shield of Texas, KBTX, 10/19/20

Health insurance provider Blue Cross and Blue Shield of Texas (BCBSTX) has said that CommonSpirit Health has notified the insurance provider that they intend to leave the network on Dec. 16, 2020….According to the insurance company, CommonSpirit is proposing rate increases that would drive up the cost of health care in Houston, Bryan-College Station, Lufkin and the rest of the southeast Texas communities they serve.”

Other negotiations: Nebraska, Washington