Compliance-watchword of healthcare companies and possible other companies in China

• King & Wood Mallesons
• China
• July 31 2013
• 

Recently, allegations of a massive bribery scheme on the part of the Chinese unit of a famous British multinational pharmaceutical company have grabbed headlines in China and abroad. China’s Ministry of Public Security officially announced on July 11 that senior executives of this company are under criminal investigation on suspicion of using travel agencies to bribe government officials, hospitals, doctors, and medical industry associations in a scheme to increase sales. Some of the company’s senior executives and employees are also suspected of taking bribes from third party vendors.

According to the news reports, the national Ministry of Public Security began the investigation in late June, when local public security bureaus visited the company’s Shanghai, Changsha and Zhengzhou offices. Reportedly, company documents have been seized and some employees detained.

While this investigation is high-profile, it is by no means alone. In early July, the National Development and Reform Commission announced an investigation into the costs and prices charged by 60 domestic and international pharmaceutical companies operating in China.

These investigations of drug makers signal China’s intention to push forward with reforms in the healthcare sector, which will impact all companies operating in that space.

It is not just healthcare companies that need to take note of these investigations. Companies in other sectors can have high compliance risks if they, for example, frequently use third party intermediaries or have a high degree of interaction with government officials or State-owned enterprises. Companies that fit this profile are advised to pay attention to enforcement trends and take proper responsive measures.

In the current regulatory climate, companies are advised to stay focused on their compliance programs to ensure that they are robust and fully implemented. Recommended steps include the following:

Review and revise internal policies and procedures on, among other things, hospitalities, “dawn raid” guidelines in the event of government inspections, employee handbooks and manuals; and the process for handling “whistleblowers;”

• Prepare a training course for employees on how to handle investigations;
• Conduct compliance and legal risk assessment;
• Review and “stress-test” internal control procedures on, among other things, financial and accounting practices;
• Conduct proactive internal audits and investigations of suspected violations;
• Conduct detailed due diligence on third party intermediaries such as agents and sales representatives;
• Take prompt action if faced with evidence or allegations of wrongdoing.

Companies should exercise caution when an investigation has been initiated before embarking on any internal assessment and audit process.

http://www.lexology.com/library/detail.aspx?g=012ac2bc-0200-48cb-adec-c4d33bd55988

Hospice Care Fraud – Fleecing the Government on Your Deathbed

2013-08-01 18:43:08 (GMT) (JusticeNewsFlash.com - False Claims, Featured, Justice News Flash, Press Release)

07/11/2013 // Justice News Flash: Featured Column // Kathleen Scanlan // (press release)

Hospice care has become such a common part of how Americans think about dying in the 21st Century that it’s hard to believe that as late as the cigarette-sucking Mad Men-era, a terminally ill American did not have the option of coming to a gentle end in a hospice care setting. Formal hospice programs didn’t yet exist in the U.S.

The idea of hospice care was first introduced to the U.S. by a British doctor, Dame Cicely Saunders, in the early 1960s, but hospice didn’t go mainstream until 1982, when Medicare began covering the treatment.

The word “hospice” can be traced back to medieval times when it referred to a lodging for travelers or a shelter for the weary. Today, hospice care is for people with terminal illnesses whose doctors say they have only a few weeks or months left to live.

Alternatively called palliative care, hospice care’s goal is to alleviate patients’ pain and discomfort in their remaining weeks or months, and to address their emotional and spiritual concerns. Care can be extended beyond six months with the approval of a certified hospice doctor. While two-thirds of hospice patients receive care at home, hospice treatment is also given in nursing homes, assisted living facilities, veterans’ facilities, hospitals, and prisons.

With the aging of the baby boomer generation, hospice care is growing steadily in the United States. Today there are an estimated 5,300 hospice programs located around the country. Since hospice facilities must be certified by the Centers for Medicare and Medicaid Services (CMS) to be eligible for federal dollars, it’s not surprising that the majority of programs are certified by Medicare, or that Medicare spent more than $12 billion to treat 1.7 million patients in 2009.

Like other Medicare-funded care, hospices bill through the government’s reimbursement system and Medicare pays the hospice provider directly, not the patient. In most states, low-income, terminally ill people under age 65 can receive hospice care through Medicaid. Payments are likewise made directly to the provider and not to the patient.

Significantly, while we think of palliative care as being an act of kindness and mercy on the patient’s death bed, only 34 percent of Medicare hospice providers are not-for-profit, while 60 percent are for-profit, as of 2011, according to the National Hospice and Palliative Care Organization (NHPCO). There’s big money to be made when there’s nothing certain in life except death and taxes.

Now that palliative care is a billion-dollar federally-reimbursed undertaking spawning huge franchises with dozens of care locations, fraud has inevitably followed.

• A doctor is given financial remuneration by a hospice company for referring patients to hospice facilities regardless of whether they are actually terminally ill.

• Doctors and employees enroll patients and bill Medicare for patients who are ineligible for Medicare hospice treatment. This may be because they were never terminally ill or they weren’t discharged when it appeared that they were no longer terminally ill (in other words, their health improved and their diagnosis changed).

• Hospice providers classify patients, saying they need “continuous” or “crisis” care, which is reimbursed at higher rates than ordinary care. In one case, a company billed Medicare for more-expensive “crisis” care for days when the patient was actually playing bingo.

• Hospice care facilities and companies pressuring their employees to aggressively market to Medicare enrollees and to meet certain enrollment and treatment goals regardless of the patients’ diagnosis. In one recent case, a national for-profit hospice chain offered a massage chair as a prize to the employee who met a certain patient admission goal.

Even though hospice is still relatively new in our society, fraud in caring for Americans as they die has all the makings of a growth industry. Fighting the building wave of fraud in hospice care will require employing the same tools that have been used to fight other kinds of fraud on the government for more than 150 years, including the False Claims Act.

Media Information:

Address: San Francisco
Phone: 866-598-1315
Url: False Claims News

Tenet Healthcare and Health Management Associates allegedly paid kickbacks for referrals of pregnant illegal residents and filed fraudulent Medicaid claims.

(Photo: J. Kyle Keener for USA TODAY)

STORY HIGHLIGHTS

• Two large hospital operators allegedly violated anti-kickback statute of Medicaid law
• Hospital Management Associates official declined comment on pending litigation
• Tenet Healthcare says agreements under fire were "appropriate"

ATLANTA (AP) — Two large hospital operators paid kickbacks to clinics that directed expectant mothers living in the U.S. illegally to their hospitals and filed fraudulent Medicaid claims on those patients, a federal whistleblower lawsuit unsealed late Wednesday said.

Naples, Fla.-based Health Management Associates and Dallas-based Tenet Healthcare and their affiliates entered into contracts with clinics operated by Hispanic Medical Management and Clinica de la Mama and their affiliates, the lawsuit says.

The clinics then referred pregnant women living in the country without authorization to for-profit hospitals operated by HMA and Tenet in exchange for kickbacks from fraudulent Medicaid claims, the lawsuit says.

The Medicare and Medicaid Patient Protection Act, known as the anti-kickback statute, prohibits paying for or accepting money to arrange for medical treatment under federally funded programs.

An HMA representative said in an email that the company does not comment on pending litigation.

Tenet issued a statement on behalf of its hospitals named in the suit, saying it believes the agreements "were appropriate and provided substantial benefit to women in underserved Hispanic communities served by those hospitals. The services provided under these agreements included translation, determination of Medicaid eligibility, and other services designed to improve the delivery of obstetric care and increase the likelihood of a safe birth and a healthy baby."

Phone numbers for Hispanic Medical Management and Clinica de la Mama, both in Georgia, could not immediately be found.

The federal whistleblower lawsuit, filed by Ralph Williams, a former chief financial officer for HMA, says the kickback scheme went on for more than a decade. The state of Georgia has also joined the lawsuit to recover state Medicaid funds.

"These hospitals paid Clinica kickbacks camouflaged as interpreter service payments to funnel emergency Medicaid patients their way and increase their bottom line," Georgia Attorney General Sam Olens said in a statement. "As attorney general, I take seriously my responsibility to protect the integrity of Georgia Medicaid and to ensure that those who defraud the program are held accountable."

Clinica recruits pregnant women who are in the country illegally to its prenatal clinics using the slogan, "we care about your health, not your immigration status," the lawsuit says. The clinics then directed these vulnerable patients to the HMA and Tenet hospitals, which pay for the referrals, the lawsuit says.

Those in the country illegally are not eligible for Medicaid coverage although hospitals can be reimbursed for treatment of emergency services provided to those in the country illegally and Medicaid rules consider childbirth an emergency medical condition.

The lawsuit says Williams began working at HMA in April 2009 and one of his duties was to monitor contracts and approve the payment of bills. Shortly after he arrived, he discovered a contract between an HMA hospital in Monroe, Ga., and Clinica for Spanish interpreter services, the lawsuit says. He investigated and found no evidence of interpreter services, but eventually found that Clinica was being paid for referring pregnant women in the country illegally "for government subsidized deliveries," the lawsuit says.

Soon after he voiced his concerns about the fraudulent arrangement to company leaders, Williams was fired without reason, the lawsuit alleges.

The lawsuit says Williams' direct supervisor had previously worked for Tenet in South Carolina. The lawsuit alleges that Tenet used a similar scheme in a number of its hospitals, including Atlanta Medical Center, four others in Georgia and Hilton Head Hospital in Hilton Head, S.C.

http://www.usatoday.com/story/money/business/2013/07/31/whistleblower-suit-hospitals-defrauded-medicaid/2607219/

Dow Inaugurates Northeast Technology Center Innovation Hub

July 31, 2013, 2:07 p.m. EDT

Major Commitment Reflects Investment in the Delaware Valley; Center to Support Innovation for Advanced Materials Portfolio of Businesses

PHILADELPHIA, Jul 31, 2013 (BUSINESS WIRE) -- Representing a new chapter in the company's storied history in the Delaware Valley, The Dow Chemical Company DOW +1.33% today inaugurated its brand new Northeast Technology Center (NTC) in Collegeville, Pennsylvania.

A world-class, state-of-the-art 800,000 square foot facility, the NTC is a global research and development hub of modern lab and office facilities providing a fully equipped, collaborative space for more than 800 employees and contractors. One of the largest sites of its kind in Dow's global network, the NTC will play a pivotal role as an innovation hub for many businesses in Dow's Advanced Materials portfolio - a business unit headquartered in Philadelphia, which brings differentiated solutions to customers in key end-markets including electronics, consumer and lifestyle, infrastructure and transportation and energy.

Speaking at a ribbon cutting event attended by more than 700 employees, contractors and community members, Pennsylvania Governor Tom Corbett said, "Today Dow is making clear that it is committed to Pennsylvania, as a place of business, as a center of research and development, and as a home of innovation. This tech center is part of something special happening all over our commonwealth. Businesses are coming here to become part of our economic comeback. That comeback has led to 130,000 private sector jobs being created; a recovery of more than 60 percent of the jobs lost during the great recession and unemployment at it the lowest rate since 2009. That's progress."

"The Northeast Technology Center is yet another example of Dow's continued commitment to innovation and collaboration," said Andrew Liveris, Dow Chairman and CEO. "Working at the intersection of the sciences, Dow scientists and technologists are bridging the gap between chemistry and technology to develop solutions to some of the world's greatest challenges."

Dow Executive Vice President and Advanced Materials Portfolio Leader Howard Ungerleider noted Dow has a heritage of innovation in the Delaware Valley: "More than fifty years ago, this region saw the invention of water-based acrylic emulsion technology, an innovation that revolutionized the way we make paint and became a national historic chemical landmark," said Ungerleider. "Today, as we gather in this new space, we can only imagine what kind of milestones we will reach in the next 50 years. It is exciting to know that this will be the point of discovery for many new innovations to come."

Dow in the Delaware Valley employs approximately 2,000 people, generates $1 billion in customer sales annually and has had a presence in the region for more than 100 years. Dow employees in the region play a significant role in innovative chemistry that betters lives and contributes to the quality of life in the tri-state area and its local communities. Products developed locally include: acrylic technology for paints, coatings and construction materials; products used to fabricate electronic chips; polymer technologies for personal care, as well as technologies for enhanced water purification and laundry care. The Company has already started moving employees from its Spring House Technical Center to the NTC and will continue the transition through 2014.

About Dow

Dow DOW +1.33% combines the power of science and technology to passionately innovate what is essential to human progress. The Company connects chemistry and innovation with the principles of sustainability to help address many of the world's most challenging problems such as the need for clean water, renewable energy generation and conservation, and increasing agricultural productivity. Dow's diversified industry-leading portfolio of specialty chemical, advanced materials, agrosciences and plastics businesses delivers a broad range of technology-based products and solutions to customers in approximately 160 countries and in high growth sectors such as electronics, water, energy, coatings and agriculture. In 2012, Dow had annual sales of approximately $57 billion and employed approximately 54,000 people worldwide. The Company's more than 5,000 products are manufactured at 188 sites in 36 countries across the globe. References to "Dow" or the "Company" mean The Dow Chemical Company and its consolidated subsidiaries unless otherwise expressly noted. More information about Dow can be found at www.dow.com.

(R)Trademark of The Dow Chemical Company ("Dow") or an affiliated company of Dow

http://cts.businesswire.com/ct/CT?id=bwnews&sty=20130731006411r1&sid=cmtx6&distro=nx

SOURCE: The Dow Chemical Company

CMS Progress Towards Greater Data Transparency

July 31st, 2013 

by Marilyn Tavenner	and	Niall Brennan

Over time it has become very clear that health care today relies on sharing data to drive improvements in access and care delivery as well as control costs.  The Centers for Medicare and Medicaid Services (CMS) has embraced the need for greater data transparency while recognizing the importance of appropriately protecting personally identifiable information (PII).

Five years ago, CMS began to actively explore opportunities to provide new avenues for accessing data in order to make data available to a broader group of users.  We are proud to say that today we are routinely and safely sharing data to support the transformation of the delivery system

Sharing data with providers. We are developing a broader strategy for providing more data to providers for performance measurement and quality improvement.  For example, CMS is:
.

• helping to promote efficiency in performance measurement through the qualified entity (QE) program.  This program creates a structure through which providers can receive a single, actionable report covering all or most of their practice.  QEs combine Medicare claims data from CMS with claims data from other payers to create comprehensive reports on the performance of hospitals, physicians, and other health care providers.
• providing Accountable Care Organizations (ACOs) with monthly claims feeds covering the almost 3 million beneficiaries being cared for by physicians participating in the ACOs.  The monthly feeds include care the beneficiary receives from both providers participating in the ACO and those that do not participate.  These data permit the ACO to coordinate care for beneficiaries and provide true patient-centered care in a fee-for-service system.
• working to improve the performance reports that providers currently receive from CMS to ensure that they are as meaningful as possible.  An example of such a report is the Quality and Resource Use Reports released to physicians and physician groups.
• developing a strategy for providing more data to more providers for performance measurement and quality improvement as required by the American Taxpayer Relief Act of 2012.

Providing Medicare data through Blue Button.  CMS has also allowed beneficiaries full and open access to their Medicare claims data through the Blue Button Initiative.  With Blue Button, Medicare beneficiaries can easily and securely download three years of Medicare Parts A, B and D data in a simple format.  Beneficiaries can then share this data with providers and caregivers through tools such as smartphone apps.

Making data available to researchers.  In addition, CMS is supporting an increasing number of researchers interested in using CMS data to conduct research to improve the healthcare system.  Since 2009, the number of research data requests we have supported has increased by nearly 300 percent.  We’ve also reached out to non-traditional researchers, such as innovative data analytics companies, to learn more about their data needs. By making the data more available, we hope to inspire users to use data in new and innovative ways that will help in our shared goal of transforming the health care system.

Maximizing data’s potential.  In the last year, CMS has also strived to make more program data available in multiple formats to spur innovation and let the private sector leverage the data to its greatest potential. This helps data innovators and entrepreneurs leverage the information in new and creative ways.  CMS is especially focused on improving the non-identifiable data that it makes available, ensuring that individuals of all skill sets can use CMS’s data resources.

In the past several months, CMS has released:
.

• three years of linked “synthetic” Medicare data that allows data entrepreneurs to develop solutions on a dataset that looks exactly like Medicare data, while protecting beneficiary privacy.
• datasets that include average hospital charges, along with average Medicare claims payments, for the 100 most common inpatient services and 30 selected outpatient services.  This data show consumers what hospitals are charging for clinically similar care.
• five years (2007-2011) of data on Medicare geographic variation at the county level.  This release supplements existing data at the state and hospital referral region (HRR) level and will enable everyone from health policy researchers, to data entrepreneurs, to consumers to better understand drivers of health care utilization, spending, and quality in their communities and across the country.
• a visually appealing dashboard using the publicly available geographic variation data to compare Medicare utilization and spending at the state level.  The dashboard allows people with a broad range of data skills to access and understand their states’ Medicare performance relative to the national average and other states.

Making data easier to find.  We also are working to better connect users with CMS data.  We recognize that publicly available CMS data are stored in many locations on the CMS website; so, in an effort to make searching for the data easier, we launched the Data Navigator last fall.  The Data Navigator uses an easy point-and-click mechanism to allow users to search for data and information products for specific CMS programs, such as Medicare and Medicaid, or on specific health care topics or care settings.

CMS’s work is just beginning – in the next year we hope to continue our data and analytics work, particularly to make our data dissemination policies more user-friendly and flexible.  However, beneficiary privacy continues to be CMS’ primary priority.  As stewards of the data, CMS has a responsibility to carefully protect this information.

That said, CMS believes that all members of the healthcare system need timely and accurate data in order to transform health care in the United States.  We are excited to continue this work, and look forward to working with you to develop innovative solutions that improve care for all Americans.

http://healthaffairs.org/blog/2013/07/31/cms-progress-towards-greater-data-transparency/

Documents shredded at Cameron hospital involved in investigation

A mediated settlement agreement filed on July 25 in Milam County has put to rest some of the troubles surrounding Central Texas Hospital in Cameron. But the legal tussles are far from over as attorneys for Dr. Tariq Mahmood prepare to fight for assets that his company, Cameron Hospitals Inc., claims to own.

Mark Humble, board president for CTH Inc., the nonprofit corporation that owns the hospital, said on Friday that Mahmood's administrators left close to $50,000 of unpaid bills and taxes on the books. He said the value of any assets should be outweighed by the debt owed to the hospital. On Monday, however, Humble said the sheriff's department discovered some shredded documents that could bring the hospital further into the federal investigation surrounding Mahmood.

FBI public affairs specialist Katy Chaumont said the bureau "had been made aware of documents that may have been destroyed." Chaumont could not confirm if the documents were from the Cameron hospital.

The week prior to the discovery, Judge John Youngblood appointed Milam County Sheriff David Greene as master in chancery over the hospital. The order handed the responsibility over to Greene after Mahmood tried to shutter the hospital's operations. Because Mahmood, or one of his agents, was attempting to close the facility, the company was breaking its lease agreement with CTH, according to Humble.

"When we filed this request for master in chancery and the temporary restraining order, that's an extremely dangerous legal maneuver," Humble said. "You're asking someone's business to be taken away from him without notice, and Texas law does not favor such things."

On July 19, the day the order was handed down, Humble said, he went against the sheriff's advice to evacuate the CTH campus -- a professional building, a former dorm for nuns and the main hospital building. Humble said administrators with Cameron Hospital Inc., Mahmood's company, told him they needed access to paperwork that was due in court the following Monday. Despite the warning from the sheriff, Humble allowed them to stay.

"One of Mahmood's employees was allowed to stay a couple days and handle what had to be handled with [Mahmood's] other operations," Humble said. He noted that CTH Inc. was only focused on gaining control of the Cameron hospital.

On Thursday, Chief Deputy Chris White told those in attendance at the settlement talks that he discovered a trash bag full of shredded documents and a box on the shredder that was full with debris. According to Humble, White had been in the hospital's copier room on July 19 to make copies of the court order. There were no signs of document shredding at the time. When White returned to the room last week, he found the bag. Humble said there were "multiple possibilities" for how someone could have gained access to the room.

"We don't know exactly how it happened. [White] said there was a window to the room that was unsecured. I think he said it was being held shut with tape or something to that effect. He moved a filing cabinet up against that window as a precaution," Humble said.

When the sheriff became master in chancery, he closed the rest of the hospital, directing all traffic through the emergency room as a precaution, Humble said. Over the course of several days, the department oversaw the changing of the locks on the hospital doors. Humble said the task probably took a couple of days to complete.

"What happened in that room is not the sheriff's fault," Humble added. "The sheriff and his deputy have gone way beyond what anybody should reasonably be asked to do. This is not what sheriffs do."

The shredded documents were taken to the sheriff's department for safe-keeping. The FBI asked hospital administrators to make a copy of the surveillance footage; however, when techs went to review the tape on Friday, they discovered the system had been offline for a week, Humble said. He did not know how the system was disabled. Because there is no footage, investigators are unable to name a suspect at this time.

Several calls to White's office were not returned.

The major highlight of the settlement is Mahmood's relinquishing of hospital operations to CTH Inc.

"It is agreed that Central Texas Hospitals Inc. shall not have any connection with Cameron Hospitals or Dr. Tariq Mahmood's federal or state provider numbers," the settlement states.

Sheriff Greene and Little River Healthcare, the company contracted to run the hospital in the interim, retain control of Central Texas Hospital under the settlement.

CTH Inc. retains all valid licenses obtained by Mahmood and Cameron Hospitals Inc.

A court date is set for Aug. 19 to continue the resolution. Attorneys for Mahmood must provide a list of all assets Cameron Hospitals is claiming it owns. If those assets are valued less than the outstanding debt, then they will be forfeited to CTH Inc.

Some of the debt includes an outstanding utility bill for $59,000 and unpaid taxes amounting to $13,000. The CTH president said the hospital's financial status is in good working order and said the debt issues stem from Mahmood's mismanagement.

"A couple months ago, Dr. Mahmood overreached when he took over the Terrell hospital. I'm guessing they were robbing Peter to pay Paul," Humble said.

Mahmood was indicted by a federal grand jury on April 11, and charged with conspiracy to commit health care fraud and seven counts of health care fraud. According to the indictment, from April 2010 to April 2013, Mahmood and others are alleged to have carried out a scheme to defraud Medicare and Medicaid through the submission of false and fraudulent claims.

On July 20, aides said Gov. Rick Perry had ordered a "deep and comprehensive look" at health care facilities owned by the Dallas-area physician, whose rural hospitals have violated safety regulations without drawing state scrutiny.

The Associated Press contributed to this report.

By Jordan Overturf jordan.overturf@theeagle.com | Posted: Thursday, August 1, 2013 12:00 am

http://m.theeagle.com/mobile/news/local/article_399642b5-f06f-56dc-ac09-c32877de55d2.html

HCA Reports Second Quarter 2013 Results

NASHVILLE, Tenn. -- 

HCA Holdings, Inc. (NYSE: HCA) today announced financial and operating results for the second quarter ended June 30, 2013.

Key second quarter metrics (all percentage changes compare 2Q 2013 to 2Q 2012 unless noted):

• Revenues increased 4.2 percent to $8.450 billion
• Net income attributable to HCA Holdings, Inc. totaled $423 million, or $0.91 per diluted share
• Adjusted EBITDA increased 7.6 percent to $1.689 billion
• Cash flows from operations totaled $814 million
• Same facility equivalent admissions increased 1.1 percent while same facility admissions increased 1.3 percent
• Same facility revenue per equivalent admission increased 2.9 percent

“We are pleased with the second quarter results, produced through volume growth, increasing acuity and favorable expense management by our operating teams,” stated Richard M. Bracken, HCA Chairman and CEO. “Our operating teams are doing an excellent job providing cost efficient and quality care,” concluded Bracken.

Revenue growth in the second quarter was reflective of increased patient volumes and improved revenue per equivalent admission. Revenue in the second quarter of 2013 increased to $8.450 billion, from $8.112 billion in the second quarter of 2012.

Same facility equivalent admissions increased 1.1 percent in the second quarter of 2013 compared to the prior year period, while same facility admissions increased 1.3 percent. On a same facility basis, emergency room visits increased 0.8 percent in the second quarter of 2013, compared to the prior year period.

Net income attributable to HCA Holdings, Inc. totaled $423 million, or $0.91 per diluted share, compared to $391 million, or $0.85 per diluted share, in the second quarter of 2012. Results for the second quarter of 2013 include gains on sales of facilities of $4 million, compared to losses on sales of facilities of $2 million in the second quarter of 2012.

Adjusted EBITDA increased to $1.689 billion compared to $1.569 billion in the second quarter of 2012. Adjusted EBITDA is a non-GAAP financial measure. Tables providing supplemental information on Adjusted EBITDA and reconciling net income attributable to HCA Holdings, Inc. to Adjusted EBITDA are included in this release.

During the second quarter of 2013, salaries and benefits, supplies and other operating expenses totaled $6.825 billion, or 80.7 percent of revenues, compared to $6.622 billion, or 81.7 percent of revenues, in the second quarter of 2012.

Six Months Ended June 30, 2013

Revenues for the six months ended June 30, 2013 totaled $16.890 billion compared to $16.517 billion in the same period of 2012. Net income attributable to HCA Holdings, Inc. was $767 million, or $1.66 per diluted share, compared to $931 million, or $2.03 per diluted share, for the first six months of 2012. Results for the six months ended June 30, 2013 include a loss on retirement of debt of $17 million, or $0.02 per diluted share, and losses on sales of facilities of $12 million, or $0.02 per diluted share. Results for the six months ended June 30, 2012 include net favorable Medicare adjustments which increased revenues by $188 million, Adjusted EBITDA by $170 million and diluted earnings per share by $0.22.

Balance Sheet and Cash Flows from Operations

As of June 30, 2013, HCA Holdings, Inc.’s balance sheet reflected cash and cash equivalents of $462 million, total debt of $28.200 billion and total assets of $27.934 billion. Total debt outstanding declined by $408 million from the first quarter of 2013. During the second quarter of 2013, capital expenditures totaled $492 million, excluding acquisitions. Net cash provided by operating activities in the second quarter of 2013 totaled $814 million compared to $1.460 billion in the prior year’s second quarter. The decline in cash flows from operating activities was primarily due to favorable changes in operating assets and liabilities during the second quarter of 2012. Accounts receivable declined $390 million during the second quarter of 2012, which included the receipt of the rural floor Medicare settlement of $271 million.

As of June 30, 2013, HCA operated 161 hospitals and 114 freestanding surgery centers.

Guidance

The Company today is reaffirming its previously issued guidance ranges for 2013.

Earnings Conference Call

HCA will host a conference call for investors at 9:00 a.m. Central Daylight Time today. All interested investors are invited to access a live audio broadcast of the call via webcast. The broadcast also will be available on a replay basis beginning this afternoon. The webcast can be accessed at:https://event.webcasts.com/starthere.jsp?ei=1019699 or through the Company’s Investor Relations web page, www.hcahealthcare.com.

Humana Reports Second Quarter 2013 Financial Results; Raises Full Year EPS Guidance

2Q13 EPS of $2.63 exceeds management’s expectationsYear-over-year second quarter pretax income up 14 percent in Retail Segment and up 9 percent in Employer Group Segment2013 EPS guidance raised to range of $8.65 to $8.752013 cash flows from operati

LOUISVILLE, KY. — Humana Inc. (NYSE: HUM) today reported diluted earnings per common share (EPS) for the quarter ended June 30, 2013 (2Q13) of$2.63, compared to $2.16 per share for the quarter ended June 30, 2012 (2Q12). Results for 2Q13 exceeded management’s previous expectations of $2.40 to $2.50 per share primarily due to strong operating performance across the company’s business units and the favorable impact of the company’s reduced share count, partially offset by pretax expenses of $31 million ($0.12 per share) in connection with the company’s pending exit from its Puerto Rico Medicaid business.

For the six months ended June 30, 2013 (1H13) the company reported EPS of $5.58 compared to $3.65 in the six months ended June 30, 2012 (1H12). The 1H13 performance reflected the items discussed above for 2Q13 along with the first quarter 2013 beneficial effect of settlement of contract claims with the Department of Defense (DoD), as well as a benefit from a delay in the impact of sequestration for the company’s Medicare business.

The company now anticipates EPS for the year ending December 31, 2013 (FY13) to be in the range of $8.65 to $8.75 versus management’s previous guidance of $8.40 to $8.60. This increase reflects the better-than-expected second quarter results discussed above.

“Our second quarter’s solid operating performance reflects the continued focus and executional discipline involved in key initiatives like our chronic care program, including increased care management professional staffing and clinical assessments,” said Bruce D. Broussard, President and Chief Executive Officer of Humana. “The favorable outcomes seen from those programs year to date reinforce our commitment to the related planned investments in the second half of 2013. We believe maintaining momentum on those and other key capability-building initiatives, together with our focus on operating cost efficiencies, will effectively position Humana to face the reform-related challenges that accelerate in 2014.”

Humana’s full detailed earnings press release has been posted to the company’s Investor Relations site and may be accessed at http://phx.corporate-ir.net/phoenix.zhtml?c=92913&p=irol-news&nyo=0 or via a current report on Form 8-K filed by the company with the Securities and Exchange Commission this morning (available at www.sec.gov or on the company’s website).

Conference Call & Virtual Slide Presentation

Humana will host a conference call, as well as a virtual slide presentation, at 9:00 a.m. eastern time today to discuss its financial results for the quarter and the company’s expectations for future earnings. A live virtual presentation (audio with slides) may be accessed via Humana’s Investor Relations page at www.humana.com. The company suggests web participants sign on at least 15 minutes in advance of the call. The company also suggests web participants visit the site well in advance of the call to run a system test and to download any free software needed to view the presentation.

All parties interested in the audio-only portion of the conference call are invited to dial 888-625-7430. No password is required. The company suggests participants dial in at least ten minutes in advance of the call. For those unable to participate in the live event, the virtual presentation archive may be accessed via the Historical Webcasts & Presentations section of the Investor Relations page at www.humana.com.

Cautionary Statement

This news release includes forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. When used in investor presentations, press releases, Securities and Exchange Commission (SEC) filings, and in oral statements made by or with the approval of one of Humana’s executive officers, the words or phrases like “expects,” “believes,” “anticipates,” “intends,” “likely will result,” “estimates,” “projects” or variations of such words and similar expressions are intended to identify such forward-looking statements. These forward-looking statements are not guarantees of future performance and are subject to risks, uncertainties, and assumptions, including, among other things, information set forth in the “Risk Factors” section of the company’s SEC filings, a summary of which includes but is not limited to the following:

• If Humana does not design and price its products properly and competitively, if the premiums Humana receives are insufficient to cover the cost of health care services delivered to its members, if the company is unable to implement clinical initiatives to provide a better health care experience for its members, lower costs and appropriately document the risk profile of its members, or if its estimates of benefits expense are inadequate, Humana’s profitability could be materially adversely affected. Humana estimates the costs of its benefit expense payments, and designs and prices its products accordingly, using actuarial methods and assumptions based upon, among other relevant factors, claim payment patterns, medical cost inflation, and historical developments such as claim inventory levels and claim receipt patterns. These estimates, however, involve extensive judgment, and have considerable inherent variability because they are extremely sensitive to changes in payment patterns and medical cost trends.
• If Humana fails to effectively implement its operational and strategic initiatives, particularly its Medicare initiatives (given the concentration of the company’s revenues in the Medicare business), the company’s business may be materially adversely affected.
• If Humana fails to properly maintain the integrity of its data, to strategically implement new information systems, to protect Humana’s proprietary rights to its systems, or to defend against cyber-security attacks, the company’s business may be materially adversely affected.
• Humana’s business may be materially adversely impacted by CMS’s adoption of a new coding set for diagnoses (commonly known as ICD-10).
• Humana is involved in various legal actions, or disputes that could lead to legal actions (such as, among other things, provider contract disputes relating to rate adjustments resulting from the Balanced Budget and Emergency Deficit Control Act of 1985, as amended, commonly referred to as “sequestration”; other provider contract disputes; and qui tam litigation brought by individuals on behalf of the government) and governmental and internal investigations, any of which, if resolved unfavorably to the company, could result in substantial monetary damages. Increased litigation and negative publicity could also increase the company’s cost of doing business.
• As a government contractor, Humana is exposed to risks that may materially adversely affect its business or its willingness or ability to participate in government health care programs including, among other things, loss of material government contracts, governmental audits and investigations, potential inadequacy of government-determined payment rates or other changes in the governmental programs in which Humana participates.
• The Health Care Reform Law, including The Patient Protection and Affordable Care Act and The Health Care and Education Reconciliation Act of 2010, could have a material adverse effect on Humana’s results of operations, including restricting revenue, enrollment and premium growth in certain products and market segments, restricting the company’s ability to expand into new markets, increasing the company's medical and operating costs by, among other things, requiring a minimum benefit ratio on insured products, lowering the company’s Medicare payment rates and increasing the company’s expenses associated with a non-deductible health insurance industry fee and other assessments; financial position, including the company's ability to maintain the value of its goodwill; and cash flows. In addition, if the new non-deductible health insurance industry fee and other assessments, including a three-year commercial reinsurance fee, were imposed as enacted, and if Humana is unable to adjust its business model to address these new taxes and assessments, such as through the reduction of the company’s operating costs, there can be no assurance that the non-deductible health insurance industry fee and other assessments would not have a material adverse effect on the company’s results of operations, financial position, and cash flows.
• Humana’s business activities are subject to substantial government regulation. New laws or regulations, or changes in existing laws or regulations or their manner of application could increase the company’s cost of doing business and may adversely affect the company’s business, profitability and cash flows.
• Any failure to manage operating costs could hamper Humana’s profitability.
• Any failure by Humana to manage acquisitions and other significant transactions successfully may have a material adverse effect on its results of operations, financial position, and cash flows.
• If Humana fails to develop and maintain satisfactory relationships with the providers of care to its members, the company’s business may be adversely affected.
• Humana’s pharmacy business is highly competitive and subjects it to regulations in addition to those the company faces with its core health benefits businesses.
• Changes in the prescription drug industry pricing benchmarks may adversely affect Humana’s financial performance.
• If Humana does not continue to earn and retain purchase discounts and volume rebates from pharmaceutical manufacturers at current levels, Humana’s gross margins may decline.
• Humana’s ability to obtain funds from its subsidiaries is restricted by state insurance regulations.
• Downgrades in Humana’s debt ratings, should they occur, may adversely affect its business, results of operations, and financial condition.
• Changes in economic conditions could adversely affect Humana’s business and results of operations.
• The securities and credit markets may experience volatility and disruption, which may adversely affect Humana’s business.
• Given the current economic climate, Humana’s stock and the stock of other companies in the insurance industry may be increasingly subject to stock price and trading volume volatility.

In making forward-looking statements, Humana is not undertaking to address or update them in future filings or communications regarding its business or results. In light of these risks, uncertainties, and assumptions, the forward-looking events discussed herein may or may not occur. There also may be other risks that the company is unable to predict at this time. Any of these risks and uncertainties may cause actual results to differ materially from the results discussed in the forward-looking statements.

Humana advises investors to read the following documents as filed by the company with the SEC for further discussion both of the risks it faces and its historical performance:

• Form 10-K for the year ended December 31, 2012 (as amended by the Form 10‐K/A filed on April 12, 2013);
• Form 10-Q for the quarter ended March 31, 2013;
• Form 8-Ks filed during 2013.
• 
  Read more here: http://www.heraldonline.com/2013/07/31/5070042/humana-reports-second-quarter.html#storylink=cpy
• 
  Read more here: http://www.heraldonline.com/2013/07/31/5070042/humana-reports-second-quarter.html#storylink=cpy