Author Topic: DVA DaVita HealthCare Partners  (Read 216279 times)

MrB

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Re: DVA DaVita HealthCare Partners
« Reply #290 on: October 04, 2017, 02:23:47 PM »
DD +1
Ok so here is something interesting to ponder.

If you read the CIA (Corporate Integrity Agreement), which was part of the Barbetta settlement https://oig.hhs.gov/fraud/cia/agreements/Davita_Healthcare_Partners_Inc_10222014.pdf

then there is a few interesting things to note.

Agreement put in place a Compliance Program (CP). Obligation was put on DVA's  Compliance Officer (Jeanine Jiganti) to affect the CP and she chairs the specially created Management Compliance Committee and she reports directly to Thiry and the Board Compliance Committee, which had 90 days to appoint a Compliance Advisor to independently review DVA's CP. Needs to be at least quarterly meetings and reports.

Independent Monitor (IM): Appointed by agreement between DVA and OIG. All monitor's reports submitted to OIG and DVA simultaneously and no draft reports are allowed with DVA. Monitor is not an agent of OIG, but OIG can remove him/her at its sole discretion. IM can retain staff, consultants, etc. 

The scope of the CP: "Arrangements" shall mean every arrangement or transaction that involves, directly or indirectly, the offer, payment, solicitation, or receipt of anything of value, and is between DaVita Dialysis and any actual or potential source of health care business or referrals to Da Vita Dialysis or any actual or potential recipient of health care business or referrals from Da Vita Dialysis....service for which payment may be made in whole or in part by a Federal health care program

So everything that relates to deals or transactions, in particular the Federal health care program, the False Claims Act and the Anti-Kickback Statute needs to be run by the committees and the IM. The IM's also has authority over "Focus Arrangements" means every Arrangement that is between DaVita and any Health Care Provider and involves, directly or indirectly, the offer, payment, or provision of anything of value. Basically any deal to buy or sell centers.

So after that mouthful there are two things I'm thinking about.
1. If DVA essentially had the OIG camping out in HQ or had extremely granular oversight, since Oct 2014 (5 year agreement) and they have to sign off on just about everything then it should be darn difficult to have any hanky panky going on including
2. any of the suggested misconduct regarding AKF and ACA, but it might also explain why DVA immediately ended premium assistance for Medicaid eligible patients late last year after it surfaced in the press (my assessment). It could be because of the CIA, which puts them on an extremely short leash if anything remotely sinister pops up.

Any lawyers want to chime in?
 


cubsfan

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Re: DVA DaVita HealthCare Partners
« Reply #291 on: October 04, 2017, 02:25:00 PM »
Mr B - thank you for contributing mightily to this DVA board. You and others are posting some great docs, like this last one.
Do you by chance have a doc discussing the David Barbetta settlement?
You're welcome.
Not sure exactly what you're after, but this will keep you busy at least.

Light read
https://www.foley.com/files/Publication/bd469faa-7ccf-46e4-8dfd-dd908fadbf99/Presentation/PublicationAttachment/ff94190f-82ca-4baf-b165-e03e820587f2/HFRA.Lori.DaVita.1210.pdf

Not so light read
https://oig.hhs.gov/fraud/cia/agreements/Davita_Healthcare_Partners_Inc_10222014.pdf

Door stop (includes excellent center specific data from Exhibit 6 onwards)
https://www.phillipsandcohen.com/wp-content/uploads/US-Barbetta-v-DaVita-First-Amended-Complaint-Exhibits.pdf

Mr. B

You gave me exactly what I was looking for - which was a high level explanation of the Barbetta Settlement, that imposes sanctions and OIG reporting requirements in place of a "death penalty" or something less extreme by the Feds.
I was trying to understand your comments about the Feds reluctance to not interrupt the business operations for the good of the patients.  The Foley & Laudner document does that. I'll work my way through the "door stop" materials! Ha! Thanks.

DooDiligence

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Re: DVA DaVita HealthCare Partners
« Reply #292 on: October 04, 2017, 05:02:19 PM »
Jeez, imagine if pharma were treated the same way...
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sleepydragon

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Re: DVA DaVita HealthCare Partners
« Reply #293 on: October 05, 2017, 08:12:45 AM »

JRM

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Re: DVA DaVita HealthCare Partners
« Reply #294 on: October 06, 2017, 04:28:15 AM »
Jeez, imagine if pharma were treated the same way...

The pharmaceutical industry is a mess in a lot of ways.

So, just to be clear; the bull thesis relies on the following to hold:

1.  The Affordable Care Act is not revised in such a way that takes away the large payouts to dialysis patients.
2.  Regulators do not remove the "self-licking-lollipop" loophole where dialysis companies contribute to AKF, then AKF helps pay the higher premiums under the ACA.

Good to know one of the reasons why my insurance premiums keep going up.

MrB

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Re: DVA DaVita HealthCare Partners
« Reply #295 on: October 06, 2017, 07:52:36 AM »
Jeez, imagine if pharma were treated the same way...

The pharmaceutical industry is a mess in a lot of ways.

So, just to be clear; the bull thesis relies on the following to hold:

1.  The Affordable Care Act is not revised in such a way that takes away the large payouts to dialysis patients.
2.  Regulators do not remove the "self-licking-lollipop" loophole where dialysis companies contribute to AKF, then AKF helps pay the higher premiums under the ACA.

Good to know one of the reasons why my insurance premiums keep going up.

I think the lens through which you view those things is critical, though.

Speaking for myself the bull thesis relies on the following,
1. Government made a moral commitment in 1973 to provide access and cover to all ESRD patients. The probability seems low that it will change.
2. Government has understood, since 1973 that it needs to retain control over serving the ESRD population if it wants to ensure access, control costs and improve quality. The probability seems low that it will change.
3. Government co-opted private healthcare companies since the early 1980s to improve access, lower costs and increase quality.  a) Access has improved in various ways, but mainly because ESRD itself is the entitlement, immediately classifies the patient as disabled and government has worked hard since the early 1980s to ensure private companies do not discriminate against ESRD patients. b) Government uses three broad strategies to drive down costs cost shifting (private), bundling (simplifying the cost structure) and capitation (capping costs) c) quality through various ways, but most recently through the star system. The probability seems low that the industry structure will change, especially considering the success since 1973; 50k v 628k patients, costs per patient per annum more than halved in real terms and quality up e.g. mortality rates more than halved.

So I look at things like ACA, AKF, etc, etc within the historical context and within the industry framework. Otherwise I find myself seeing the wood for the trees. Not saying those are not valid short to medium term issues, just that I think history and industry structure is poorly understood, which results in a low quality investment decision. 

DooDiligence

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Re: DVA DaVita HealthCare Partners
« Reply #296 on: October 06, 2017, 08:16:21 AM »
Jeez, imagine if pharma were treated the same way...

The pharmaceutical industry is a mess in a lot of ways.

So, just to be clear; the bull thesis relies on the following to hold:

1.  The Affordable Care Act is not revised in such a way that takes away the large payouts to dialysis patients.
2.  Regulators do not remove the "self-licking-lollipop" loophole where dialysis companies contribute to AKF, then AKF helps pay the higher premiums under the ACA.

Good to know one of the reasons why my insurance premiums keep going up.

I think the lens through which you view those things is critical, though.

Speaking for myself the bull thesis relies on the following,
1. Government made a moral commitment in 1973 to provide access and cover to all ESRD patients. The probability seems low that it will change.
2. Government has understood, since 1973 that it needs to retain control over serving the ESRD population if it wants to ensure access, control costs and improve quality. The probability seems low that it will change.
3. Government co-opted private healthcare companies since the early 1980s to improve access, lower costs and increase quality.  a) Access has improved in various ways, but mainly because ESRD itself is the entitlement, immediately classifies the patient as disabled and government has worked hard since the early 1980s to ensure private companies do not discriminate against ESRD patients. b) Government uses three broad strategies to drive down costs cost shifting (private), bundling (simplifying the cost structure) and capitation (capping costs) c) quality through various ways, but most recently through the star system. The probability seems low that the industry structure will change, especially considering the success since 1973; 50k v 628k patients, costs per patient per annum more than halved in real terms and quality up e.g. mortality rates more than halved.

So I look at things like ACA, AKF, etc, etc within the historical context and within the industry framework. Otherwise I find myself seeing the wood for the trees. Not saying those are not valid short to medium term issues, just that I think history and industry structure is poorly understood, which results in a low quality investment decision.

This is definitely more complicated than I thought at 1st.

Thanks to you & others for explaining the situation to a 5 year old (me.)

It's a 4% position for me & if it dropped another 10% I may or may not push it up to 6% (would probably do it with long dated calls & maybe shorting some puts.)

Cognitive biases everywhere...
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Retail 9.0% - ULTA VLGEA

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i trumpet my ignorance

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MrB

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Re: DVA DaVita HealthCare Partners
« Reply #297 on: October 09, 2017, 02:59:35 AM »
Yep not the simplest story DD. Maybe JPM gets you to your -10%

09-Oct-2017 09:57:54 AM - DAVITA INC DVA.N: JP MORGAN CUTS TARGET PRICE TO $51 FROM $66 -Reuters News

DooDiligence

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Re: DVA DaVita HealthCare Partners
« Reply #298 on: October 09, 2017, 08:05:43 AM »
Yep not the simplest story DD. Maybe JPM gets you to your -10%

09-Oct-2017 09:57:54 AM - DAVITA INC DVA.N: JP MORGAN CUTS TARGET PRICE TO $51 FROM $66 -Reuters News

Anatomy of a knife catcher:

1. Thinks he's right but EEEK! OK, breathe & go watch Wayne Brady do Let's Make a Deal.

2. OK, calmed down enuf to tear away from LMAD & re-read COBF DVA thread.

3. Realizes that downward price wishes seem nicer when you're just wishing for them.

4. Still want to go long, long Calls (if it goes down some more.)

Which will probably segue to a scene in the ER's hand bandaging room.

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If Fidelity doesn't list JPM's rating, do they matter?  :o

Neutral 2 Underweight, pfffft, let's some Sell's from all these neutrals.

« Last Edit: October 09, 2017, 08:15:15 AM by DooDiligence »
BRK.B - 24.9% // Healthcare 22.5% - EW NVO // Auto's & Oil 18.4% - CLB GPC PSX VDE

Banking 9.4% - WFC // Entertainment 4.7% - DIS // Drinkers & Smokers 6.4% - MO

Retail 9.0% - ULTA VLGEA

---

%'s held @ MV 2/25/20 fully invested
18 months of $

i trumpet my ignorance

https://twitter.com/tunawis

walkie518

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Re: DVA DaVita HealthCare Partners
« Reply #299 on: October 09, 2017, 08:28:36 AM »
JPM  is certainly after the fact...

I bought more today