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Around the nation: Dozens of hospitals sue HHS over alleged Medicare underpayments


More than two dozen  hospitals are suing HHS over years of alleged Medicare underpayments, in today's bite-sized hospital and health industry news from Arizona, the District of Columbia, and Michigan. 

  • Arizona: Banner Health last week announced that its longtime CEO Peter Fine will retire June 30. Fine was named president and CEO of Banner in 2000 after the merger of Samaritan Health System and Lutheran Health System in 1999. After his retirement, Fine said he plans to serve in an advisory role as CEO emeritus until January 2025. Amy Perry, Banner's current president, will succeed Fine as CEO and hold both titles going forward. According to Modern Healthcare, Perry first joined Banner in November 2021 as president and COO. Before that, she was EVP of care delivery at Atlantic Health and led its hospital division. (Hudson, Modern Healthcare, 4/9)
  • District of Columbia: More than two dozen hospitals are suing HHS and HHS Secretary Xavier Becerra, alleging that a decades-old error led to years of Medicare underpayments. In the lawsuit, the hospitals argued that HHS miscalculated the Inpatient Prospective Payment System (IPPS) base payment rate for fiscal year (FY) 1984, leading to years of incorrect Medicare payments. Plaintiffs in the lawsuit, which include Allina Health, Ochsner Health, and Tampa General Hospital, have asked for higher Medicare payments from FY 2019 to 2023, along with an unspecified amount in damages. "Despite having specific knowledge of his error in fiscal year 1984 and later acknowledging in fiscal year 1992 that his calculation methodology was 'problematic,' [Becerra] has yet to adjust the IPPS standard amount to correct for his inclusion of transfer cases in the costs per discharge calculation," the lawsuit said. According to an HHS spokesperson, the agency cannot comment on ongoing litigation. (Kacik, Modern Healthcare, 4/12)
  • Michigan: According to a new study published in JAMA Health Forum, tubal ligations and vasectomies among people ages 18 to 30 saw significant increases after the Dobbs v. Jackson Supreme Court decision ended the constitutional right to abortion. For the study, researchers analyzed medical records from academic medical centers and affiliated clinics nationwide between Jan. 1, 2019, and May 31, 2022, before Dobbs, and between June 1, 2022, and Sept. 30, 2023, after Dobbs. Overall, researchers found that there were 58 more tubal ligations per 100,000 outpatient visits and 27 more vasectomies per 100,000 visits after the Dobbs decision. "Findings from this research highlight the indirect effects of Dobbs on the reproductive autonomy of young people," said Jackie Ellison, an assistant professor of health policy and management at the University of Pittsburgh School of Public Health and the study's lead author. Ellison also noted that the findings "demonstrate how abortion restrictions disproportionately impact women and people who can get pregnant," since the number of tubal ligations was twice that of vasectomies. "It may seem obvious, but it's important to emphasize that cisgender men may not feel the same sense of urgency to undergo vasectomy because they don't experience the same consequences of unwanted pregnancy," she said. (Holcombe, CNN, 4/12; Mantel, NBC News, 4/12)

Your guide to CMS' 14 value-based payment models

CMS' value-based payment models can be complex, but this field guide breaks them down for you. Discover the different payment structures and stakeholder eligibility of each model and gain a better understanding of how they disrupt the traditional fee-for-service approach.


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