A look at Ballad Health CEO, Alan Levine, and his journey to leading a state-created medical monopoly.
Watching the December 2, 2012 episode of 60 Minutes, you might have thought that HMA’s Executive Vice President, Alan Levine, was at the end of his career. At the 8:58 mark in the “Hospitals: The Cost of Admission” video, Kroft begins his interview with Levine.
Kroft: “The allegations have to do with you taking people who shouldn’t be admitted to the hospital and putting them in the hospital.”
Levine: “Those allegations are absolutely wrong.”
Kroft: “HMA doesn’t set quotas for hospital admissions?”
Levine: No.
Kroft: “HMA never told emergency rooms that they needed to admit a certain percentage of people that came in?”
Levine: “We tell them collaboratively that our goal is to make sure the patient gets in the right setting. We don’t want a patient going home that should be admitted. We don’t want a patient admitted that shouldn’t be admitted.”
At this point in the interview, Levine appears calm and confident in his position regarding HMA’s admissions practices. He’s adamant that the company isn’t pressuring emergency room physicians to admit patients inappropriately. And then this happens…
Kroft: “I’ve got some documents here from Durant, OK.”
Kroft proceeds to show Alan Levine a physician performance review from the HMA hospital in Durant, OK which had been provided to 60 Minutes by a physician there. The document prominently showed an admission goal of 20%.
At the 10:05 mark in the video, Kroft questions Levine about the document.
Kroft: “It says there on the right hand side, “goal, 20%.” And it shows the lights. The reds show people who are not actually meeting their goal.”
Levine: “Well, first of all, I’ve never seen this document, so I can’t… I mean, you… The… I can tell you right now, as a company… Well, there’s a lot of things on this form, Steve. We look at testing guidelines. There’s a lot of quality metrics on here, Steve. We measure all of this stuff.”
Kroft: “Yeah, but there… We have here one whole column, “goal.”
Levine: “That’s not…”
Kroft: “Goal.”
Levine: “That’s not… That’s not from our company, Steve. I don’t know where that came from.”
Kroft: “It’s not from your company? It’s… one of your hospitals.”
Levine: “Steve, we don’t have any kind of goals. I don’t know what the… the percent admissions are at that hospital. Maybe they are actually 20%, but the… the… The admissions goal at any hospital is driven only by what the normal trend is for that hospital.”
The discomfort of this exchange is obvious to anyone watching. Levine appears unsettled by the document, apparent proof that HMA did, in fact, have an admissions goal for the physicians. He goes from saying he’s never seen the document, to saying that they measure the quality metrics on the document, to saying that the document isn’t from HMA.
Just eight months later, Alan Levine would announce that he’s leaving HMA for a position with Mountain States Health Alliance. It begs the question, what healthcare system would recruit him following this interview? And why?
As it turns out, HMA was billing government health care programs for inpatient services that should have been billed as outpatient or observation services. They also paid remuneration to physicians in return for patient referrals and submitted inflated claims for emergency department facility fees according to the Department of Justice press release on September 25, 2018.
HMA agreed to pay over $260 million to resolve criminal charges and civil claims related to false billing and kickback arrangements that defrauded the government. The press release states that the $216 million civil part of the settlement resolves HMA’s “liability for submitting false claims between 2008–2012 as part of its corporate-wide scheme to increase patient admissions of Medicare, Medicaid and the Department of Defense’s (DOD) TRICARE program beneficiaries over the age of 65.”.
Alan Levine served as the Florida Group President and Senior Vice President at HMA from August 2010 to January 2014 according to his Linkedin profile.
HMA isn’t the only company Levine has worked for that the DOJ has determined committed false claims billing fraud or participated in illegal kickback arrangements.
In June 2021, the DOJ released a statement regarding Brian Bravo, the former Procurement Director at Broward Health. Bravo pled guilty in federal district court to a federal conspiracy charge, admitting that he accepted kickbacks from vendors and a consultant in exchange for awarding them lucrative government contracts during his ten years at Broward Health from 2005–2015.
Brian Bravo wasn’t Broward Health’s first encounter with the Department of Justice. In September 2015, Broward Health agreed to a $69.5 million dollar settlement under the False Claims Act as a result of kickbacks and Stark violations.
The Third Amended Complaint Under the Federal False Claims Act in United States ex rel. Reilly v. North Broward Hospital District, et al., Case №10–60590 details how from 2004–2011, Broward Health over compensated their physicians based on the volume of referrals.
According to the complaint (pg. 41), in 2009 the whistleblower, Dr. Reilly had a conversation with then CEO, Frank Nask, questioning “why the orthopedic surgeons were paid at such high levels to cause major operating losses each year.” Nask responded not by denying the losses, but by saying “We are making money off these guys. These numbers don’t include what they bring in with labs, PT, diagnostics, etc. You didn’t include the ancillaries in the final figure.”
Before being named the CEO of Broward Health in 2008, Frank Nask was the Chief Financial Officer for the healthcare system from 2006–2008. He reported to Alan Levine who was the Chief Executive Officer at Broward Health from 2006–2008.
Another interesting note is that Levine and Nask also worked together for HCA, formerly known as Columbia/HCA.
And that brings us to the third company Alan Levine has worked for that was found guilty of Medicare, Medicaid fraud. At $1.7 billion dollars, it’s the largest healthcare fraud case in history.
In 1992, Levine began his internship at HCA. Between 1992–2003, he would hold various positions including Associate Administrator positions, Chief Operating Officer, and Chief Executive Officer for HCA. Longtime ally of Levine, Rick Scott founded and led HCA until he was forced to resign by the Board of Directors in 1997 after the investigation into HCA became public knowledge.
In a tale that is all too familiar at this point, HCA pled guilty to 14 corporate felonies for fraudulent billing practices including giving kickbacks to physicians for referrals, using fake diagnostic codes to increase reimbursement to the hospitals, and illegally claiming non-reimbursable marketing and advertising costs as community education. Three of the 14 corporate felony pleadings were to defraud the government.
So, before coming to Mountain States Health Alliance (now, Ballad Health), the three private healthcare systems he held executive level positions with were all found guilty of healthcare fraud committed during his years of service.
Correlation does not equal causation.
In fact, in all the research I’ve done, I have only found one instance where Alan Levine is specifically named in a whistleblower lawsuit regarding healthcare fraud. A 2017 Florida Bulldog article detailing the 2016 whistleblower lawsuit by then Broward Health Commission Chairman, David Di Pietro, states that in 2006, 21st Century Oncology’s former CEO, Dr. Daniel Dosoretz, “promised then-CEO Alan Levine that in return for accepting 21st Century’s proposal, the company’s doctors would refer high volumes of patients to Broward Health for surgeries, admissions and other services.”
The primary focus of the lawsuit was a 25-year no bid contract awarded to 21st Century Oncology for radiation oncology services at Broward Health. The company has financial ties to Rick Scott, who was Governor of Florida at the time. Frank Nask was CEO of Broward.
Interesting that the same names keep showing up, right?
In 2018, a judge ruled against the lawsuit citing “lack of particularity”. In other words, not enough specific details of exactly what happened, when, where, and by whom.
So, what does all this mean? Why take the time to outline the 30 year career of a healthcare executive?
Because Alan Levine is now the CEO of a literal medical monopoly in a region that is geographically the size of New Jersey. Ballad Health owns every hospital in the region. The majority of Ballad Health’s patients are on government healthcare programs like Medicare, Medicaid, and TRICARE. The healthcare monopoly operates under a Certificate of Public Advantage and thanks to a law introduced by one of their contracted vendors/consultants, Senator Rusty Crowe, much of the transparency originally intended for the public is now deemed private and unavailable.
I am not saying that fraud is happening at Ballad Health.
I am saying that it’s impossible to know what is or isn’t happening and that should concern us.
