HCA Holdings 2012 Annual Report Download - page 38

• whether the Company’s revenues from upper payment limit (“UPL”) programs, or other Medicaid
supplemental programs developed through a federally approved waiver program (“Waiver Program”),
will be adversely affected because there may be reductions in available state and local government
funding for the programs; and
• reductions to Medicare payments CMS may impose for “excess readmissions.”
Because of the many variables involved, we are unable to predict the net effect on the Company of the
expected increases in insured individuals using our facilities, reductions in Medicare spending, reductions in
Medicare and Medicaid DSH funding, and numerous other provisions in the Health Reform Law that may affect
the Company. Further, it is unclear how efforts to repeal or revise the Health Reform Law and remaining or new
federal lawsuits challenging its constitutionality will be resolved or what the impact would be of any resulting
changes to the law.
General Economic and Demographic Factors
Budget deficits at federal, state and local government entities have had a negative impact on spending for
many health and human service programs, including Medicare, Medicaid and similar programs, which represent
significant payer sources for our hospitals. Other risks we face during periods of economic weakness and high
unemployment include potential declines in the population covered under managed care agreements, increased
patient decisions to postpone or cancel elective and nonemergency health care procedures, increases in the
uninsured and underinsured populations, increased adoption of health plan structures that shift financial
responsibility to patients and further difficulties in our collecting patient copayment and deductible receivables.
The Health Reform Law seeks to decrease over time the number of uninsured individuals, by among other things
requiring employers to offer, and individuals to carry, health insurance or be subject to penalties. However, it is
difficult to predict the full impact of the Health Reform Law due to the law’s complexity, lack of implementing
regulations or interpretive guidance, gradual and potentially delayed implementation, remaining or new court
challenges, and possible amendment or repeal.
The health care industry is impacted by the overall United States economy. The federal deficit, the growing
magnitude of Medicare expenditures and the aging of the United States population will continue to place pressure
on federal health care programs.
Compliance Program
We maintain a comprehensive ethics and compliance program that is designed to meet or exceed applicable
federal guidelines and industry standards. The program is intended to monitor and raise awareness of various
regulatory issues among employees and to emphasize the importance of complying with governmental laws and
regulations. As part of the ethics and compliance program, we provide annual ethics and compliance training to
our employees and encourage all employees to report any violations to their supervisor, an ethics and compliance
officer or a toll-free telephone ethics line. The Health Reform Law requires providers to implement core
elements of compliance program criteria to be established by HHS, on a timeline to be established by HHS, as a
condition of enrollment in the Medicare or Medicaid programs, and we may have to modify our compliance
programs to comply with these new criteria.
Antitrust Laws
The federal government and most states have enacted antitrust laws that prohibit certain types of conduct
deemed to be anti-competitive. These laws prohibit price fixing, concerted refusal to deal, market
monopolization, price discrimination, tying arrangements, acquisitions of competitors and other practices that
have, or may have, an adverse effect on competition. Violations of federal or state antitrust laws can result in
various sanctions, including criminal and civil penalties. Antitrust enforcement in the health care industry is
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