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Mineral Wells Index / Saturday, August 18, 2018 u Call Classifieds at 940-327-0838 page 2
PPGH officials responding to questionable billing practice
From page 1 October 2017 for aller- allergy/DNA lab tests 1 states. “We view this as
gy/DNA lab tests, all to Quotable billed through PPGH. a form of pass-through
Brooks’ 11-year leader- people who had never “We are getting billing, we believe such
ship has not been one of been to PPGH and some “Based on some of requests and we are claims are improper and,
those financially- who didn’t know where refunding,” Smith said. it is our position that
strapped hospitals. the hospital or Mineral the revenue num- “It is trickling in.” these circumstances con-
PPGH officials are
reluctant to talk about
Wells is located.
Hospital officials say
bers that were on Brooks went to the
PPCHD board in
stitute a pattern of abu-
sive billing and give rise
what they have learned the billing was not sent the financials we December and was to a reasonable suspicion
and what has transpired by PPGH directly but approved an expendi- of fraud.”
in recent weeks after rather through a third-
began asking some ture of $90,000 for the Several insurance
questions surfaced and party company, mainly questions of Harris purchase of an allergy/ companies address pass-
an internal investigation HealthReconn Connect Baker-Boyd DNA analyzer, accord- through billing practices
initiated. For one thing, LLC, which lists two regarding the reve- ing to information pro- on their websites, includ-
there is an FBI probe international offices and nue and the outside lab service. vided by PPGH. But the ing Aetna, Cigna and
underway. FBI officials a U.S. office based in hospital spent $235,000 Blue Cross-Blue Shield
have reportedly told Lewisville, Texas. The Based on his answers, it kind of and had two analyzers of Texas.
PPGH officials no cur- company billed state- moved forward from there.” delivered earlier this “The performing phy-
rent hospital personnel ments under PPGH’s year. The hospital as sician, professional pro-
are under investigation. Clinical Laboratory
– Lori Baker-Boyd July 31 was reportedly vider, facility or ancillary
FBI officials did search Improvement President, Palo Pinto County Hospital still testing and calibrat- provider is required to
Brooks’ office and Amendments, or CLIA, District Board of Directors ing the analyzers and bill for the services they
removed some items. number. had not billed any render unless otherwise
Both PPCHD The Centers for patients or insurance approved by BCBSTX,”
President Lori Baker- Medicare & Medicaid and HealthReconn he said. “I need to work companies for tests per- Blue Cross-Blue Shield
Boyd and hospital dis- Services regulates non- Connect. Warren said with the auditors on formed at the hospital. of Texas states.
trict attorney Rhett research laboratory test- those are used when how they want to do it.” Hospital officials say According to Aetna’s
Warren say what has ing performed on there is going to be an Hopes are the hospital of some 6,500 allergy/ website, “Effective Sept.
happened is neither a humans in the U.S. exchange of confidential will not have to pay DNA lab tests billed for 1, 2017, we’ll deny pass-
reflection of nor has any through the CLIA pro- patient information. back more than the dating back to October through billing for most
direct impact on the hos- gram. In total, CLIA cov- According to PPGH, approximately $2 mil- 2017, all were collected lab charges from a facili-
pital’s staff, operations ers approximately 260,000 of the $55 million in lion remaining. Brooks and analyzed outside of ty or a non-facility pro-
or its lab department. laboratory entities. The allergy/DNA lab tests, told the Index the hospi- PPGH. They say collec- vider. The provider that
“This is purely a busi- CLIA program’s objective the hospital received tal was realizing a profit tions were made across performs the test must
ness issue,” said Warren. is to ensure quality labo- $8.7 million. Warren of about $125,000 a Texas, with about 56 bill for these services.
“The public can be con- ratory testing. confirmed what Brooks month through the lab samples actually coming We will pay for pass-
fident that the medical In dismissing Brooks, previously told the tests billings, or about from outside the state, through billing during
and health-care services who spent 19 years total Index that no bills went $1.5 million in annual and labs in Houston, an inpatient hospital
provided by PPGH are at PPGH, the board also to government-backed net revenue. Maryland and Georgia admission. We will also
unaffected by these terminated any contracts insurers like Medicare Of the outstanding performed the analyses. pay facilities for pass-
issues, and the PPGH or agreements with or Medicaid. Hospital amount that has gone In May, insurers through billing for mem-
family will continue to HealthReconn Connect records show 92 percent unpaid by private insur- Aetna and Cigna issued bers receiving outpatient
provide the same high- as well as MedHealth of the billed amount ance or individually letters to PPGH ques- services at the facility
quality of care that it Solutions LLC, went to private insurers billed patients, some of tioning allergy/DNA and for specimen collec-
has provided for the Dunwoody Labs Inc., and 8 percent billed it now several months lab test billings essen- tion that occurs at the
past 50 years.” Synergene Laboratory directly to patients. old, Smith said that indi- tially requesting proof facility on the same day
Baker-Boyd agreed, LLC, X-Gene, Principle Of the $8.7 million cates questions the billed the lab services were as other service.”
saying they will work Genetics LLC, Aeon PPGH has received to parties have about the performed at the hospi- Cigna’s website also
through the issues but Global Health, date, more than $6 mil- origin of the statements. tal. Aetna’s letter to warns about pass-through
that they are unrelated Maplewood Laboratories lion was paid to labs “I think that speaks PPGH was more direct: billing practices: “Please
to overall medical ser- LLC, DLS Research & and service providers volumes,” Smith said of “Specifically, we note that pass-through
vices and operations. Ventures and Elite for their services. the tens of millions of believe that you are sub- billing is not permitted
“This is a business Healthcare Management. Current interim hos- dollars billed but mitting claims for urine for tests that are not per-
issue,” she said. PPGH officials said pital CEO and Chief unpaid. The hospital has drug screening and other formed by you. These
In response to ques- there no contracts with Financial Officer Daniel stopped accepting fur- laboratory tests that tests may not be billed to
tions and requests for those companies have Smith said the remain- ther payments related to were not performed at Cigna or any Cigna affili-
information by the been found to date, ing funds in PPGH’s allergy/DNA lab tests. your facility but, rather, ate, payer affiliate, payer,
Index, PPGH officials though business associ- possession will be set PPGH said it has were performed at one or participant.”
say $55 million was ate agreements were aside and used to satis- returned $205,618 to or more independent ref- Humana also address-
billed out under PPGH’s provided for Elite fy return requests. insurance companies erence laboratories,” es pass-through billing
name beginning in Healthcare Management “I plan on doing that,” and individuals for Aetna’s letter dated May See PPGH, page 11

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