This Thursday, February 21, 2013, Wachler & Associate's Founder, Andrew Wachler, will present Medicare Appeals & Reimbursement Impacted by New OIG Report for the RAC University's Live Webcast. Recently, the Office of Inspector General (OIG) released a report entitled Improvements are Needed at the Amdministrative Law Judge Level of Appeal. Sign up for the webcast to learn what impact the OIG's findings and recommendations to CMS could have on your Medicare appeal strategy.
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Wachler & Associates partner, Amy K. Fehn, was recently quoted in Home Health Line regarding an agency's liability for a business associate's HIPAA violations. She explains that even though business associates are separately liable for HIPAA violations, an agency will also be liable for the business associate's noncompliance. An agency should notify affected patients of any HIPAA breach caused by a business Associate.
Last year, the American Board of Internal Medicine (ABIM) suspended 139 doctors following an investigation into the practices of the Arora Board Review test-prep company. ABIM claimed that the doctors violated ethical and conduct standards by providing test questions to the company.
Wachler & Associates represented over 40 doctors that were suspended without regard to their individual behavior and circumstances. The story, however, has gained national traction and appeared today on the front page of CNN's website.
Most of the cases against the suspended doctors have been resolved. Drew Wachler, an attorney who handled many of those cases, told CNN, "The cases were really resolved through settlement agreements with ABIM."
"We articulated the impact on these physicians," Wachler said. "We tried to present their body of work throughout their entire careers, looking at the extraordinary references they received, their conduct throughout medical school, residencies. It was resolved in that fashion."
Mr. Wachler's comments demonstrate the due process and individual consideration we fought to ensure each doctor received during the appeal process. For all healthcare providers, ethical and integrity matters are exacerbated by related issues such as licensing, participation in managed care organizations, and staff privileges. This issue highlights the collateral consequences that may be impacted by board certification, thus requiring doctors to always defend claims to ensure their continued ability to practice medicine.
A short version of this story will air on January 13th at 8:00 p.m. ET on CNN's "AC360," and the full version will air on "CNN Presents," January 14th and 15th at 8:00 p.m. and 11:00 p.m. ET.
If you have any questions or concerns regarding the ABIM suspensions or appeal process, or if you are facing board certification, licensure, managed care participation, or staff privilege issues, please contact a Wachler & Associates attorney at 248-544-0888.
Andrew Wachler Quoted in the American Medical News Regarding National Practitioner Data Bank's Move to Shut Down Public Access
Andrew Wachler, principal of Wachler & Associates, P.C., was quoted in last week's American Medical News article regarding the National Practitioner Data Bank's move to shut down public access to anonymous information about physician activities. The move was made to protect physician confidentiality after a reporter was able to identify an individual physician's record for a news article. Mr. Wachler stated that the government acted correctly in shutting down public access, which will result in the protection of the peer review process.
If you have questions regarding Medicare, Medicaid or third party payor audits, or have any other health law questions, please contact a Wachler & Associates attorney at 248-544-0888.
If the rumors are true, tomorrow the Centers for Medicare and Medicaid Services, the Office of the Inspector General and the Federal Trade Commission will be releasing voluminous regulations governing the formation of Accountable Care Organizations ("ACO") and the Medicare Shared Savings Program. But before we receive all the minutiae of the regulations, we wanted to provide a brief overview of what is already known about ACOs.
1. The purposes of ACOs are to: (1) facilitate coordination and cooperation, (2) improve the quality of care and (3) reduce unnecessary costs.
2. ACOs were created by the Affordable Care Act, which was signed by President Obama approximately one year ago.
3. In order to be an ACO, providers will have to develop a formal legal structure to receive and distribute the shared savings that are at the heart of the ACO program.
4. ACOs will have to affiliate with enough primary care providers for a minimum of 5,000 beneficiaries and will need to agree to participate in the program for a minimum of three years.
5. As this system will be based on data and evidenced-based medicine, ACOs will be required to have processes in place to "(a) promote evidenced-based medicine, (b) report the necessary data to evaluate quality and cost measures" and "(c) coordinate care."
6. ACOs must be able to demonstrate patient-centered criteria. However, we will have to wait for the regulations to determine how CMS defines "patient-centeredness."
7. Patient experience will be one of the quality measures included in the program, along with patient outcomes and utilization.
8. ACOs will be able to be formed using a variety of different business models. The statute specifies the group practices, networks of practices, joint ventures between hospitals and physicians and hospitals employing physicians will all be acceptable and it is possible, through the regulations, that the Secretary will bless other business models. In crafting a business model, state-specific issues (such as corporate practice of medicine and possibly insurance regulations) will likely play a role.
9. ACOs will have to be structured to comply with the stark law, the Anti-Kickback Statute, existing Medicare rules as well as state fraud & abuse laws (corporate practice of medicine, fee splitting, etc.) While there may be some new exceptions and safe harbors created, ACOs are going to be given carte blanche to disregard existing fraud and abuse laws.
10. The anticipated start date of the program is January 1, 2012 and providers that are appropriately structured can enroll in ACOs after that date.
It is important for providers to understand that significant time and money will go into establishing an ACO and there is no guarantee that the shared savings will lead to a recoupment of these start-up costs. However, ACOs, along with several other new payment models that will be tested as part of the Affordable Care Act, may allow providers to share in savings achieved through coordination of care and increased use of quality data.
Please stay tuned for future articles and blog entries about Affordable Care Organizations once the regulations are published. If you have any questions regarding Affordable Care Organizations please contact Andrew Wachler, Amy Fehn or Alicia Chandler at 248-544-0888.
Andrew Wachler quoted in the Detroit Free Press regarding DMC's Settlement with the Federal Government
Andrew Wachler, principal of Wachler & Associates, P.C., was quoted in today's Detroit Free Press regarding the Detroit Medical Center's (DMC) $30 million settlement with the Federal government for violations of the Anti-Kickback Statute and Stark for improper financial relationships with referring physicians. Mr. Wachler stated that the DMC case sends a message that the government has a significant focus on inappropriate relationships with doctors.
For more information on Wachler & Associate's Stark and Anti-Kickback Statute practice, please visit www.wachler.com or contact a Wachler & Associates attorney at 248-544-0888.
Andrew Wachler presented "The New Audit Landscape: MICs, MACs, and RACs" for an American Bar Association (ABA) teleconference
Andrew Wachler, principal of Wachler & Associates, P.C., presented "The New Audit Landscape: MICs, MACs, and RACs" in an American Bar Association (ABA) teleconference with James Sheehan, New York Medicaid Inspector General.
On Monday, April 6, 2010, Andrew Wachler was a guest speaker at the RAC Monitor webinar, where he discussed Medicare inpatient/outpatient reimbursement issues and the financial impact they have on hospitals and health systems.