PODCAST: The Mark Cuban Cost Plus Drug Co (MCCPDC)

By Staff Reporters

Mark Cuban, not Congress, will give Americans cheaper prescription drugs

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When universal health care fails to pass in Congress, there’s always Mark Cuban to fall back on. The billionaire and Dallas Mavericks owner launched an online pharmacy this week in order to combat the price gouging of prescription drugs by large pharmaceutical companies.

Citation: https://www.r2library.com/Resource/Title/0826102549

The Mark Cuban Cost Plus Drug Co. (MCCPDC) will offer more than 100 generic drugs that will be purchased directly from the manufacturers and sold online with a 15 percent markup across the board and a small pharmacist fee. For context, pharmaceutical companies generally mark prices up at least 100 percent and up to 1000 percent in some cases.

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PBM Forum Wrap Up: Greater Transparency, Further Congressional Review  Needed to Lower Drug Prices - United States House Committee on Oversight  and Government Reform

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READ: https://www.msn.com/en-us/money/other/its-quite-a-country-when-mark-cuban-not-congress-will-give-americans-cheaper-prescription-drugs/ar-AAT2KJ3?li=BBnb7Kz

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PODCAST: How to Read Healthcare Insurance Reports

BY ERIC BRICKER MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

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https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

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PODCAST: Hospital Innovation Will Happen

By Eric Bricker MD

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1. 18% of Healthcare Workers have left their job since 2020.

2. 66% of ICU and Acute Care Nurses have considered leaving.

3. ICUs are so short staffed that they have had to run at 4:1 patient to nurse ratios… the normal is 2:1.

4. A Florida hospital spent $24 Million in 2021 on temporary workers to cover for labor shortages… normally they spend $1 Million per year.

5. Nurses average age is 52 and 19% of nurses are over 65 … the nursing workforce is older because younger people do not want the job.

Why?

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TELE-MEDICINE Fraud, Abuse and New Barriers!

Telemedicine: Fraud and Abuse During the COVID Pandemic

By Susan Walberg

The COVID-19 pandemic has brought with it huge challenges for people all over the world; not only the obvious health-related concerns but also shutdowns, unemployment, financial difficulties, and a variety of lifestyle changes as a result.

When the COVID pandemic struck, CMS quickly recognized that access to care would be an issue, with healthcare resources strained and many providers or suppliers shutting down their offices or drastically limiting availability. Patients who needed routine care or follow-up visits were at risk for not receiving services during a time when healthcare providers were scrambling to enhance infection control measures and implement other new safety standards to protect patients and healthcare workers.

The Centers for Medicare and Medicaid Services (CMS) has responded by easing restrictions and regulatory burdens in order to allow patients to receive the healthcare services they need without undue access challenges. One key area that has changed is the restrictions related to telehealth services, which were previously only paid by Medicare under certain circumstances, such as patients living in remote areas.

Among the changes and waivers CMS has offered, telemedicine reimbursement is among the more significant. Telemedicine services, which includes office visits and ‘check ins’ are now allowed and reimbursed by Medicare. In addition to reimbursement changes, CMS has also relaxed the HIPAA privacy and information security enforcement standards, paving the way for providers to adopt a new model of providing services electronically.

TELE-HEALTH BARRIERS: https://www.statnews.com/2021/07/13/telehealth-provisions-emergency-patients/

See the source image

MORE:  https://medicalexecutivepost.com/2021/05/18/fraud-schemes-of-few-medical-providers/

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SPIKE: Hospitals Suing Patients for Unpaid Medical Bills

By Staff Reporters

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Spike in Hospitals Suing Patients for Unpaid Medical Bills

 •  Lawsuits over unpaid bills for hospitals rose by 37% in Wisconsin from 2001 to 18.
 •  Wage garnishments from the lawsuits rose 27% in that time period.
 •  5% of hospitals account for 25% of lawsuits. Nonprofit hospitals and critical access hospitals are more likely to sue patients, according to the study.
 •  There were 1.86 lawsuits per 1,000 Black residents in 2018, compared to 1.32 per 1,000 white residents.

Source: YaleNews, December 6, 2021

HEALTH ECONOMICS CITE: https://www.r2library.com/Resource/Title/0826102549

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Healthcare Consumers Want Personalized Experiences

By Staff Reporters

A survey that Redpoint Global conducted with Dynata of more than 1,000 US healthcare consumers found:

 •  57% of healthcare consumers think retailers and/or financial services are better at providing personalized omnichannel experiences than healthcare
 •  29% said they expect frictionless check-in experiences across apps/phone calls/in-office
 •  34% expect data inputs in a healthcare portal (health history, surveys, insurance information, etc.) to
    reach providers
 •  24% of respondents said they did not utilize any sort of digital communication with providers during
    the pandemic
 •  14% said they had no contact with any healthcare provider during the same timeframe

Source: Redpoint Global, December 7, 2021

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Financial Management Strategies for Hospitals and Healthcare Organizations

SPONSOR: http://www.CertifiedMedicalPlanner.org

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PODCAST: Prescription Patient Assistance Programs

BY ERIC BRICKER MD

With 43 Million Americans Having Lost Their Job at Some Point During the Pandemic and About 1/2 Those Jobs Providing Health Insurance… the 1st Group–People Who Do Not Have Health Insurance–Needs to Be Aware of How These Programs Work.

In this Video You Will Learn the Patient Assistance Program Process for:

1) 2 of the Most Common Types of Insulin

2) The Highest-Revenue Medication in America: Humira

**Note: At the Time of the Video’s Recording, the Unemployment Rate in the US was 15%. As of November 2021, the Unemployment Rate is 4.2%.

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CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: Hospital Charity Care Explained

BY ERIC BRICKER MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: Healthcare Re-Imagined

COMMON BRIDGE” WITH RICH HELPPIE

Richard Helppie's Common Bridge

Colleague Richard Helppie interviews Dean Clancy

Dean Clancy is a senior health care policy fellow at Americans for Prosperity and a nationally known health care freedom advocate and domestic policy expert with more than twenty years’ high-level policy experience in Congress, the White House, and the U.S. health care industry.

EDITOR’S NOTE: I first met Rich in B-school, when I was a student, back in the day. He was the Founder and CEO of Superior Consultant Holdings Corp. Rich graciously wrote the Foreword to one of my first textbooks on financial planning for physicians and healthcare professionals. Today, Rich is a successful entrepreneur in the technology, health and finance space.

-Dr. David E. Marcinko MBA CMP®

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PODCAST: https://richardhelppie.com/dean-clancy/

ASSESSMENT: Your thoughts are appreciated.

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31% of Americans Don’t Know How They’d Pay for Severe Illness

By Staff Reporters

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31% of Americans Don’t Know How They’d Pay for Severe Illness

A recent survey by HealthcareInsider that polled 1,062 adults aged 18 and up asked, “If you were to experience a severe illness how would you pay for treatment?”

 •  Don’t know: 31%
 •  Credit card: 26%
 •  Non-retirement savings: 17%
 •  Borrow money from family: 16%
 •  Retirement savings: 11%
 •  Health Savings Account: 9%
 •  Borrow from a finance institution: 8%
 •  Crowdfund online: 6%

Source: HealthCareInsider, December 2nd, 2021COMMENTS APPRECIATED.

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18% of Patients Surveyed Skipped Prescriptions to Save Money

By Staff Reporters

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18% Surveyed Skipped Prescriptions to Save Money

A recent Gallup survey asked “Thinking about the last 12 months, have you or a family member skipped a prescribed pill, dose, or other type of medication in order to save money?”. The amount of prescriptions in the household of those who answered yes varied as follows:

 •  8+: 25%
 •  5-7: 22%
 •  1-4: 17%
 •  0: 8%
 •  Total that answered yes: 18%

Source: West Health-Gallup 2021 Healthcare in America Report, December 2021

CITE: https://www.r2library.com/Resource/Title/082610254

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Personal Financial Planning for Physicians and Medical Colleagues

ME Inc = Going it Alone but with a Team

BY DR. DAVID EDWARD MARCINKO MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

The physician, nurse, or other medical professional should easily recognize that there are a vast array of opportunities, obstacles, and pitfalls when it comes to managing one’s finances.  Still, with some modicum of effort, the basic aspects of insurance, investments, taxes, accounting, portfolio management, retirement and estate planning, debt reduction, asset protection and practice management can be largely self-taught. Yet, it is realized that nuances and subtleties can make a well-intentioned financial plan fall short.  The devil truly is in the details.  Moreover, none of these areas can be addressed in isolation. It is common for a solution in one area to cause a new set of problems in another. 

Accordingly, most health care practitioners would be well served to hire [independent, hourly compensated and prn] financial help. Unlike some medical problems, financial issues may not cause any “pain” or other obvious symptoms.  Medical professionals tend to have far more complex financial situations than most lay people. Despite the complexities of the new world of health reform, far too many either do nothing; or give up all control totally, to an external advisor. This either/or mistake can be costly in many ways, and should be avoided. 

In reality, and at various time in their careers, the medical professional needs a team comprised of at least a financial analyst, lawyer, management consultant, risk manager [actuary, mathematician or insurance counselor] and accountant. At various points in time, each member of the team, or significant others, will properly assume a role of more or less importance, but the doctor must usually remain the “quarterback” or leader; in the absence of a truly informed other, or Certified Medical Planner™.

This is necessary because only the doctor has the personal self-mandate with skin in the game, to take a big picture view.  And, rightly or wrongly, investments dominate the information available regarding personal finance and the attention of most physicians.  One is much more likely to need or want to discuss the financial markets with their financial advisor than private letter rulings by the IRS, or with their estate planning attorney or tax accountant. While hiring for expertise is a good idea, there is sinister way advisors goad doctors into using all their retail services; all of the time. That artifice is – the value of time. 

True integrated physician focused and financial planning is at its core a service business, not a product or sales endeavor. And, increasingly money is more likely to be at the top of the list for providers as the healthcare environment is contracting.

So, eschewing the quarterback model of advice, and choosing to self-educate thru this book and elsewhere, may be one of the best efforts a smart physician can make.

ASSESSMENT: Your thoughts are appreciated.

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

ORDER TEXTBOOK: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

RELATED TEXTS: https://medicalexecutivepost.com/2021/04/29/why-are-certified-medical-planner-textbooks-so-darn-popular/

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PODCAST: Hospital Financial Cross Subsidization Explained

BY ERIC BRICKER MD

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PODCAST: Ray Dalio on How the Healthcare Economy Works

Economy Works’ Applied to Healthcare … Credit Cycles and Healthcare Policy

By Eric Bricker MD

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HEALTH ECONOMICS CITE: https://www.r2library.com/Resource/Title/0826102549

RICARDIAN DEMAND HEALTH ECONOMICS: https://medicalexecutivepost.com/2021/12/14/ricardian-derived-demand-economics-in-medicine/

RISING HEALTH CARE COSTS: https://medicalexecutivepost.com/2018/03/11/medical-treatment-costs-becoming-expensive-25-factors/

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PODCAST: Future Hospital “Profit Pool” in 2022?

McKinsey Healthcare Industry Analysis – Future Sources of Hospital Profit

BY ERIC BRICKER MD

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PODCAST: Direct Healthcare Contracting

How it Works for Employers and Hospitals?

BY DR. ERIC BRICKER MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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RISK MANAGEMENT TEXT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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PODCAST: CIGNA Executive Public Relations “Whistle Blower”

Wendell Potter is a Famous Ex-Executive from Cigna Who Left His High Paying PR Job in 2007 to Reveal the True Story Behind Health Insurance Carrier Public Relations.

BY ERIC BRICKER MD

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Hospital Settles False Claims Act Allegations for $18.2 Million

BY HEALTH CAPITAL CONSULTANTS, LLC

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Hospital Settles False Claims Act Allegations for $18.2 Million


On December 2, 2021, the U.S. Department of Justice (DOJ) announced that it had entered into an $18.2 million settlement with Flower Mound Hospital, a 91-bed hospital located northwest of Dallas, to resolve claims that the hospital had violated the Stark Law, the Anti-Kickback Statute (AKS), and the False Claims Act (FCA) by making improper inducements to referring physicians. This Health Capital Topics article will review the facts underlying the settlement. (Read more…)

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PODCAST: https://medicalexecutivepost.com/2021/08/28/podcast-stark-and-aks-final-rules/

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PODCAST: How to Sell in Healthcare During the Pandemic

BY ERIC BRICKER MD

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Marketing V. Advertising V. Sales: https://medicalexecutivepost.com/2020/03/09/on-marketing-adverting-and-sales/

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PODCASTS: Employer Sponsored Health Plans Explained [Part I and II]

Self and Fully Insured Fundamentals and Basics

[A Two Part Presentation]

DR. ERIC BRICKER MD

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CITE: https://www.r2library.com/Resource/Title/0826102549

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PODCASTS: How Prescription [Rx] Coverage Works

Formulary Tiers, PBM, Rebates, Spread-Pricing Explained

By Dr. Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: Why Tech Companies Fail at Health Care

HEALTH PLAN “AGE” AS RISK FACTOR

BY ERIC BRICKER MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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RISK MANAGEMENT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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PODCAST: Milliman Medical Care Guidelines

Pervasive MCG Health Insurance Denials

BY ERIC BRICKER MD

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New Study Compares Medicare-Commercial Payment Gaps by Specialty

New Study Compares Medicare-Commercial Payment Gaps by Specialty

BY HEALTH CAPITAL CONSULTANTS


Utilizing data from FAIR Health, the Urban Institute conducted an October 2021 study which reviewed commercial insurance claims across the U.S. (for approximately 60 insurers and third-party administrators covering over 150 million Americans under age 65) from March 2019 through February 2020.

CITE: https://www.r2library.com/Resource/Title/0826102549

This study assessed the gap between commercial insurance payments and Medicare payments for professional physician services to determine whether the payment gap between Medicare and commercial insurance differs by specialty. (Read more…)

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PODCASTS: The Case Against Value Based Care [VBC]

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And Now – The Other Perspective

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BY ERIC BRICKER MD

Your comments are appreciated.

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CITE: https://www.r2library.com/Resource/Title/0826102549

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https://www.amazon.com/Hospitals-Healthcare-Organizations-Management-Operational/dp/1439879907/ref=sr_1_4?s=books&ie=UTF8&qid=1334193619&sr=1-4

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https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

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PODCAST: VBC Financial Risks: https://medicalexecutivepost.com/2021/07/13/podcast-value-based-care-financial-risks/

ENJOY

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PODCAST: What a Hospital CEO Should Do?

Operational and Financial Changes

BY ERIC BRICKER MD

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CMS Innovation Center Launches “Bold New” Strategy

BY HEALTH CAPITAL CONSULTANTS, LLC

CMS Innovation Center Launches “Bold New” Strategy


When President Joe Biden was elected in 2020, there was much anticipation and speculation regarding what his election would mean for the U.S. healthcare industry in the coming years.

CITE: https://www.r2library.com/Resource/Title/0826102549

Thriving in a value-based health care model - Biotricity

As an ardent supporter of the Patient Protection and Affordable Care Act (ACA) who campaigned on offering a public insurance option similar to Medicare, many in the healthcare industry assumed that the Biden Administration would be a strong proponent of continuing the shift to value-based care, which shift was largely spurred by his predecessor and former boss, Barack Obama, with the passage of the ACA. (Read more…)

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PODCAST: Health Insurance Plan Designs

HMOs, PPOs, POS and CDHPs; etc.

BY ERIC BRICKER MD

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Citation: https://www.r2library.com/Resource/Title/0826102549

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TRIFECTA Update: Markets, Covid and Congress

TOPICS PREVIOUSLY MENTIONED ON THE ME-P

By Staff Reporters

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  • Markets: Omicron who? Fed tapering what? Stocks continued to roar back from their post-Thanksgiving hangover, with tech shares leading the way. The NASDAQ had its best day since March.
  • Covid: Pfizer’s Covid-19 vaccine is less effective, but still provides some protection, against the Omicron variant, an early study from South Africa showed.
  • US Government: Congress had a busy evening. Lawmakers reached a deal to raise the country’s debt ceiling, and the House passed a $768 billion defense policy bill that increases pay for service members.
  • Citation: https://www.r2library.com/Resource/Title/0826102549

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PODCAST: Health Insurance for H.I. Company Employees

What Health Insurance Do Health Insurance Companies Give Their Own Employees?

By Eric Bricker MD

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PODCAST: Fee-for-Service Primary Care

DUMB?

For Employers, On-Site Clinic or Direct Primary Care is Best!

By Eric Bricker MD

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BUSINESS: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?s=books&ie=UTF8&qid=1287563112&sr=1-9

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HOSPITALS: https://www.amazon.com/Hospitals-Healthcare-Organizations-Management-Operational/dp/1439879907/ref=sr_1_4?s=books&ie=UTF8&qid=1334193619&sr=1-4

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PODCAST: Low-Value Healthcare Remains Even Without Fee-for-Service Incentives

BY ERIC BRICKER MD

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MORE: https://medicalexecutivepost.com/2021/05/27/activity-based-medical-cost-accounting-and-management/

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PODCAST: Healthcare Costs Rising

Doctors, Hospitals, Pharma and DMEs

BY ERIC BRICKER MD

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PODCAST: NaviHealth Digital Health Start-Up

SOLD TO OPTUM

BY ERIC BRICKER MD

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PODCAST: Five [5] Warning Signs for Virtual Primary Care

FROM HEALTH INSURANCE CARRIERS

BY ERIC BRICKER MD

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PODCAST: Value-Based Care

Ochsner Health Has Real Hospital Success

By Dr. Eric Bricker MD

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Physician Medical Practice “Misrepresentation” Risks

BUSINESS FRAUD RISKS

True Case Report

CMP logo

By Dr. David Edward Marcinko MBA CMP©

SPONSOR: http://www.CertifiedMedicalPlanner.org

A Medical Practice Misrepresentation Case Model

Let’s say a physician decided to sell his practice and move to another state. The value of the sale was based, in part, on the yearly gross of the practice. The physician accepted installment payment terms from the buyer and moved to the new state. The buyer began to practice medicine at his new office. Although he was busy, his gross never approached the gross of the prior physician.

Eventually the buyer defaulted on the loan. The selling physician sued for the deficit. The defaulting physician and his forensic consultants then performed an in-depth evaluation of the seller’s practice. The buyer and his team noticed some discrepancies in the billing patterns and practices of the seller. Considering these discrepancies to constitute Medicare and insurance billing fraud, the seller counter-sued the buyer on the grounds of misrepresentation, alleging the gross receipts of the practice purchase price, was grossly inflated.

Citation: https://www.r2library.com/Resource/Title/0826102549

ASSESSMENT: Therefore, the buyer determined that the seller had fraudulently misrepresented the potential of the practice. He also notified state and federal authorities and filed complaints of insurance fraud against the seller.

The seller thought that he would move to the good life in the new state, but his old practice kept him in constant legal trouble.

YOUR THOUGHTS ARE APPRECIATED

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors : Best Practices from Leading Consultants and Certified Medical Planners™ book cover

Order Textbook: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

SECOND OPINIONS: https://medicalexecutivepost.com/schedule-a-consultation/

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PODCAST: The EMTALA Law

Hospitals Must Treat All Patients

BY ERIC BRICKER MD

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The Emergency Medical Treatment and Active Labor Act is an act of the United States Congress, passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act

CITE: https://www.r2library.com/Resource/Title/0826102549

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MORE: https://medicalexecutivepost.com/2009/04/26/understanding-the-emergency-medical-treatment-and-active-labor-act/

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PODCAST: Ascension Non-Profit Hospital System

THE LARGEST IN THE USA

BY DR. ERIC BRICKER MD

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PODCAST: Health Insurance Claims Repricing

WHAT IT IS – HOW IT WORKS

By Eric Bricker MD

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HEALTH INSURANCE ADJUDICATION

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PODCAST: Centene the Giant Medicaid HMO

MEDICAID AND A.C.A. the GIANT

By Eric Bricker MD

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HOSPITALS: https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

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HEALTHCARE: https://www.amazon.com/Hospitals-Healthcare-Organizations-Management-Operational/dp/1439879907/ref=sr_1_4?s=books&ie=UTF8&qid=1334193619&sr=1-4

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