More Ways UMC and CCC are Violating Medicare & Medicaid Rules

If EPCH and UMC follow the HwH model it will allow the El Paso Children’s Hospital to have a higher reimbursement rate from Medicare and Medicaid and will keep it off of the tax payer’s bill.  However, if UMC or the County Commissioners do not follow the rules set forth, do not maintain a separate organizational structure, one of the following could occur for BOTH Hospitals and the individuals involved:

  1. At the Hospital level: “The CMPL authorizes penalties of up to $50,000 per violation, and assessments of up to three times the amount claimed for each item or service, or up to three times the amount of remuneration offered, paid, solicited, or received.”  That means that the hospitals would be seriously fined to the point where both of them would end up in bankruptcy.
  2. “Providers and health care organizations that commit health care fraud risk exclusion from participation in Federal health care programs and the loss of their professional licenses.” One or both hospitals could lose their ability to get ANY reimbursements for Medicare and Medicaid as well as lose the ability to file for federal money to support Children’s Hospitals and indigent care. Again, this could push both hospitals into bankruptcy.
  3. “Committing Medicare fraud exposes individuals or entities to potential criminal and civil remedies, including imprisonment, fines, and penalties.”  Those who were involved in this could  have their careers destroyed and could end up in JAIL.

You can read about Medicare Fraud and Abuse here.

So, apart from the interlocking board member, we’ve discovered other parts of the plan between EPCH and UMC that also violate the HwH model (as a reminder, the HwH model REQUIRES that both hospitals maintain organizational separation):

  1.  “Final selection of the Reorganized Debtor’s new CEO shall be a joint decision of the UMC and EPCH board.” (pg 26). This means that UMC boards ALSO gets to select the new CEO for the El Paso Children’s Hospital. How can you argue separate organizations when the Host Hospital is ‘helping’ to select the new CEO?
  2. “For a minimum period of two (2) years following the Effective Date, any increases or decreases in the Reorganized Debtor’s services shall be implemented only with the prior approval of CCC.” (pg 26).  This means that the Commissioners Court, who is part of the Host Hospital UMC, will get to make operational decisions regarding services at the Children’s Hospital.  If one entity is controlling how services are implemented and taken away, then these are NOT SEPARATE ORGANIZATIONS!
  3. UMC gets to appoint 4 board members but they also get final approval over the people that the EPCH physicians and the outgoing board members appoint. (pg.25-26).  If they can’t come to an agreement, then the County Commissioners get to make the decision on who ultimately serve.  Does that sound separate to you?  Yeah, it didn’t to us, either.
  4. Interlocking board member Miguel Fernandez – we feel we have adequately covered this one, so refer you to our other posts for more information.
  5. Service contracts that exceed the 15% rule – we have also addressed this item in other posts.

These are just a few of the items we have found, we have no doubt that there are others.

We have no desire to see the El Paso Children’s Hospital fail.  However, we also do NOT want to have to continue to pay for it.  We understand why the County Commissioners and UMC may have felt the need to put these provisions in.  HOWEVER, in their zeal to ‘take the keys’ of the hospital, they have not only set it up for failure, they are headed into some illegal territory that could result in bankruptcy of BOTH UMC AND EPCH AS WELL AS PERSONAL LEGAL RAMIFICATIONS FOR THE COUNTY COMMISSIONERS.

If you need a refresher, you can read the entire joint plan here.

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