NEWS

NEWS

Calif. Recovers Over $1 Million from PacifiCare/UnitedHealth Group

Insurance Commissioner Steve Poizner and Cindy Ehnes, director of the California Department of Managed Health Care (DMHC), filed a joint action against PacifiCare companies, owned by UnitedHealth Group, in response to more than 130,000 alleged claims-handling violations. This joint endeavor is a historic step in the efforts of both the California Department of Insurance (CDI) and DMHC to put an end to the practice of unfair claims handling in the health insurance industry, according to a DMHC press release. This collaborative effort is the first action ever by both CDI and DMHC against a single health plan or insurer.

After receiving hundreds of consumer and provider complaints about claims payment problems by PacifiCare, particularly after it was acquired by United Healthcare in late 2005, CDI and DMHC took action and launched a joint investigation in 2007 into PacifiCare’s alleged unfair practices.

PacifiCare’s alleged violations cited by CDI and DMHC include:

• Wrongful denials of covered claims 
• Incorrect payment of claims 
• Lost documents including certificates of creditable coverage and medical records 
• Failure to timely acknowledge receipt of claims 
• Multiple requests for documentation that was previously provided 
• Failure to address all issues and respond in a timely manner to member appeals and provider disputes 
• Failure to manage provider network contracts and resolve provider disputes 
• Similar provider claims payment violations have been established by the DMHC, and the plan has been assessed a penalty of $3.5 million, the largest fine imposed by the DMHC.

Carol Offers Consumers A Shopping Portal for Healthcare Services

A Web site launched for Michigan healthcare consumers offers a one-stop shopping resource for local healthcare providers and procedures. The Web site lists retail prices, discounted network prices and out-of-pocket costs for Carol visitors, and already is partnered with several health insurance providers.

For more information, visit https://www.carol.com/aboutus/index.html. 

MedAssets Renews Sempermed Contract

MedAssets Supply Chain Systems, the group purchasing division of MedAssets, Inc., has renewed its contract with glove manufacturer Sempermed USA for its complete line of examination gloves. The multi-year agreement began Jan. 1, and includes the SemperCare® line as well as the Polymed® Latex Powder- Free exam gloves.

Washington State Says No Money for Never Events

“Ethical billing practices” will become a reality in Washington state following the creation of a joint resolution drafted by the Washington State Hospital Association, the Washington State Medical Association and the Washington Ambulatory Surgery Center Association (WASCA). The “Resolution on Adverse Events and Patient Safety” says patients will no longer be billed for care should a preventable adverse event occur.

“Washington hospitals, physicians, and ambulatory surgery centers will work with all payers to ensure this policy is implemented in a fair and consistent manner,” the resolution reads.

“The WASCA motto is ‘our patients come first,’” asserts WASCA president Terry Hawes, vice president of National Surgical Care. “WASCA feels that it is very important to join the governor and other parties in support of this issue. We don’t think that no charges for ‘never events’ will impact our industry, as we are very proud of our track record. Our goal is to be at the table for all major public policy issues in healthcare; to have a good relationship with the governor and to have bipartisan support of the ASC industry. WASCA has superb strategic counsel from our staff; our legal counsel, Emily Studebaker; our lobbyist, Jim Jesernig; our executive director, Rob Schwartz; and our board of directors.”

AMA Offers Nondiscrimination Statement, Profiling How-To

The American Medical Association (AMA) produced a sample nondiscrimination statement intended to be inclusive of all patients for physicians to frame and display in their offices. This sample statement was recently updated as a result of a policy adopted by the AMA House of Delegates to ensure the inclusion of transgender physicians, medical students and patients in AMA policies. Visit www.ama-assn.org to download the document.

The AMA also developed “Physician profiling: How to prepare your practice,” to help physicians brace their practice for profiling programs used by many health insurers. This resource, a follow-up to a separate AMA-produced resource, “How to challenge your ‘profile’ or placement in a tiered or narrow network,” offers five steps that encompass the basic elements of the physician profiling process — contract language, program metrics, data, coding and patient education. For more information, visit www.ama-assn.org/ama1/pub/upload/mm/368/5steps-flyer.pdf. 

Cogdell Spencer Inc. Announces Merger with Marshall Erdman and Associates

Cogdell Spencer Inc. announces that it executed a definitive merger agreement to acquire 100 percent of the stock of Marshall Erdman and Associates, a design-build firm that specializes in the advance planning, designing, and building of healthcare facilities throughout the United States. The value of the transaction is $247 million, subject to adjustment. Erdman will operate as a subsidiary of Cogdell Spencer Inc.

By integrating Erdman’s platform with Cogdell Spencer’s extensive portfolio management, the company will offer the full range of healthcare real estate services to an expanded client base that includes healthcare systems, physician tenants and practice groups. The combined company will operate nationwide with offices in Atlanta, Charlotte, Charleston, Columbia, Dallas, Denver, Madison, Seattle and Washington, D.C. Madison will remain the headquarters for Erdman. Charlotte will remain the corporate headquarters for Cogdell Spencer Inc.

“Our merger with Erdman will produce the most integrated healthcare real estate facilities firm in the nation,” says Frank C. Spencer, president and CEO of Cogdell Spencer Inc. “With over 90 years of combined experience, we will be able to provide clients with the full range of complementary, strategic services from advance planning to capital to property management.”

The merger creates a national integrated healthcare real estate company with more than 600 employees and 2007 combined revenue of approximately $365 million. The combined company has developed or constructed 1,500 medical office buildings, 160 multi-specialty medical facilities, 700 specialty centers, 135 ambulatory surgery centers and 1,000 rural hospitals and health centers in all 48 continental states.

“By serving an expanded client base, we believe this merger will create significant shareholder value over the long term,” Spencer adds. Scott Ransom, president and CEO of Marshall Erdman and Associates, will continue to lead Erdman, reporting to Spencer. Management will otherwise remain unchanged in both firms.

“Erdman was seeking a strategic partner in healthcare real estate and selected Cogdell Spencer, a pioneer in healthcare development, physician ownership, and asset and property management,” says Ransom. “In partnering with Cogdell Spencer, we have positioned the company for continued growth through expansion of services and strengthening of client relationships.”

Cogdell Spencer will finance the acquisition through the following sources:

• A $100 million term loan arranged by KeyBank National Association with participation from Bank of America, N.A., Branch Banking and Trust Company, M&I Marshall & Ilsley Bank and Wachovia Bank 
• An $85 million rollover of equity held by Marshall Erdman’s principal shareholders (Baird Capital Partners and Lubar & Co.) and members of its management team 
• Borrowings under a new $150 million secured line of credit arranged by Bank of America, N.A. with participation from KeyBank National Association, Branch Banking and Trust Company, M&I Marshall & Ilsley Bank and Wachovia Bank Separately, Cogdell Spencer announced that it has priced a private offering of $55 million of common shares to an initial purchaser who intends to resell such shares to institutional investors at a price of $15.95 per share.

Cogdell Spencer Inc. intends to use the net proceeds from the private offering initially to reduce borrowings under its existing unsecured revolving credit facility. Any remaining net proceeds will be used for working capital purposes, including potential future development and acquisition activities.

KeyBank Capital Markets Inc. acted as the financial advisor to Cogdell Spencer. Wachovia Capital Markets LLC acted as the advisor to Marshall Erdman and Associates. Clifford Chance US LLP acted as legal advisor to Cogdell Spencer, while Godfrey & Kahn represented Marshall Erdman in the transaction.

MWE’s 2008 Symposium

Industry experts from around the nation met in Hollywood, Fla., in February for an update on the state of the industry, presented at the annual Symposium hosted by McDermott Will and Emery. This year’s event co-chairs were MWE partners Jerry J. Sokol and Eric Zimmerman.

Share this article: Email, Slashdot, Digg, Del.icio.us, Yahoo!MyWeb, Windows Live Favorites, Furl
Add this article feed to: RSS, My Yahoo, Newsgator, Bloglines