Rachel Carey, Esq.’s Post

Proposed #legislation in #California would require approval from the state's attorney general for #healthcare #transactions involving #privateequity or hedge funds and healthcare facilities or provider groups. The bill marks the latest indication of increased scrutiny of private equity deals in the industry. Read our team's analysis of the proposals and their implications for stakeholders. #healthcareregulation Kenneth Yood | Shalyn Watkins

Fascinating findings from recent data! The Georgia Northern Bankruptcy Court leads the pack with 534 Chapter 11 petitions filed, a significant number related to healthcare. In second place, the Delaware Bankruptcy Court follows closely with 118 Chapter 11 petitions, focusing on healthcare, pharmaceuticals, and clean energy. Assisted living and nursing homes appear to be prominent in the healthcare cases. #BankruptcyCourt #Healthcare #DataAnalysis

The 6/14 Healthcare Labyrinth Newsfeed is live. Click below to read. Major stories: -- FTC has bad record on mergers -- More on MA Star recalculations -- Will lawmakers tackle Medicare solvency? -- Medicare pilots scrutinized -- PE's impact on healthcare #healthcare #healthcarereform #healthinsurance The Healthcare Labyrinth Marc S. Ryan 🇺🇦

An August 14 report by Gibbins Advisors, a healthcare restructuring advisory firm, analyzed Chapter 11 bankruptcy cases among medical industry companies with more than $10 million in liabilities from the beginning of January 2019 to the end of June 2024. Researchers found that while there was a sharp rise in bankruptcies in Q3 2023, the number of filings has decreased in the following three quarters through Q2 2024.

Senior DOJ Official Calls Out Multiple Industry Segments in Outlining DOJ’s FCA Priorities (Part 1) Brian Boynton, Principal Deputy Assistant Attorney General, spoke the other day to the Federal Bar Association, and his prepared remarks were filled with interesting tidbits. Here are the takeaways: • No Real Shade Thrown at Drug Makers: In a noticeable departure from similar speeches for more than a decade by other DOJ officials, Boynton did not make pharmaceutical drug makers the centerpiece of his FCA overview. In fact, there was no mention of them in the prepared remarks. Why? Three reasons: (1) the focus of his speech is “old news”, (2) there was in 2023 no relevant big manufacturer resolution to trumpet, and (3) the point of the speech was to emphasize other targets of interest. • No Big Cases, But Lots of Activity: The largest case described in the speech was, by historical standards, a relatively “mid-sized” settlement of $345 million involving Community Health Network, in a hospital Stark Law case. But the absence of a blockbuster settlement was offset by loads of activity: 543 FCA resolutions (a 54% increase from 2022), 712 new qui tams (the third highest yearly total), and more than 500 non-qui tam “case starts” (an “all time record”). • Medicare Advantage Takes Another Hit: Boynton trumpeted the Cigna risk adjustment resolution. He also took swings at the “similar claims” involving United, Independent, Kaiser, and Elevance. And then (rather ominously) he promised that, “[g]oing forward, “the department expects to expand its focus … to include an examination of the role that vendors and providers play” in risk adjustment. • Private Equity in the Cross Hairs: Private equity firms, he charged, need to be held “accountable” when they “cause the submission of false claims”. He also alleged that “private equity firms or venture capital firms” were “influenc[ing] provider behavior” and “patient care”, by “providing express direction for how a provider should conduct their business, or more indirectly by providing revenue targets or other indirect benchmarks intended to prioritize reimbursement”. It’s pretty strong rhetoric. Some of what he appears to be calling out, of course, like providing revenue targets and “indirect benchmarks” to improve reimbursement, just sound like common business practices. But Boynton’s remarks seem intended to cast a shadow over these basic elements of business oversight and management. His criticism ends with the statement that private equity and other third parties are not “inherently problematic”—gee, thanks. • Health IT and EHRs: Boynton highlighted two AKS cases in the EHR space, criticized some EHRs for being “corrupted to bias certain types of medical decisions”, and took issue with their role in “upcoding” and “improperly inflat[ing]” Medicare payments. Part 2 will cover the rest. #fca #healthcarecompliance #medicareadvantage #privateequity

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Please comment before May 6, 2024 at the link: US Department of Justice’s Antitrust Division, the Federal Trade Commission, and the Department of Health and Human Services are concerned that transactions may generate profits for those firms at the expense of patients’ health, workers’ safety, and affordable health care for patients and taxpayers. They seek public comment regarding the effects of transactions involving health care providers (including providers of home- and community-based services for people with disabilities), facilities, or ancillary products or services, conducted by private equity funds or other alternative asset managers, health systems, or private payers. They are interested in public input regarding the goals or objectives of these transactions, as well as their effects on participants in the health care market including patients, communities, payers, employers, providers, and other health care workers and businesses You can comment as an individual, as an organization or anonymously. Comment at this link before May 6, 2024: https://lnkd.in/gvBU2_gT https://lnkd.in/g999cQX4

Check out this article by one of our Founding Partners: Private Equity (PE) funds often invest in medical practices through MSOs, a model that has recently faced criticism in several states. Structuring PE-owned MSOs as Benefit Corporations may help to mitigate concerns. Learn more here: #Healthcare #MSO #PrivateEquity

Follow up to my earlier rant today about the evils of Private Equity investing. Earlier today I pointed out that the critical problem with Private Equity is that it was very possible for deal sponsors to make a fortune themselves while screwing vulnerable employees and suppliers. With healthcare, not only do they screw vulnerable employees and suppliers, but they also very likely kill patients. See: Steward Healthcare #PrivateEquity #Wallstreet #Stewardhealth Massachusetts, California Weigh New Curbs on Private-Equity Medical Acquisitions https://lnkd.in/ez6P2x7B