Articles Posted in Health Law

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The Centers for Medicare and Medicaid Services (CMS) published a proposed rule implementing provisions of the Patient Protection and Affordable Care Act (PPACA) that help tackle Medicare and Medicaid fraud.  According to Peter Budetti, the Director of the new anti-fraud office at CMS, the proposed rules will provide federal authorities the power to identify fraud and reduce improper payments by an estimated $55 billion.

According to CMS, the proposed rule is essential to the implementation of healthcare reform since the expansion of healthcare coverage relies upon saving money on fraud and abuse in the healthcare systems.  Specifically, the rules will provide increased scrutiny to $900 billion in annual spending in federal Medicare, and the state-federal Medicaid and Children’s Health Insurance Program (CHIP), but it is unknown how much money the proposed rules will actually save.

Increased scrutiny over Medicare and Medicaid Programs will include the following measures:

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U.S. District Judge Roger Vinson indicated last Tuesday that he will likely allow a lawsuit to proceed that challenges the Constitutionality of the Healthcare Reform law.  The lawsuit, filed by 20 states, the National Federation of Independent Business and two individuals, challenges whether the Constitution permits the federal government to mandate Americans to purchase health insurance.  Earlier this summer the Obama Administration requested Judge Vinson to dismiss the lawsuit, arguing that the challenge requests the court to overturn precedent enforcing the federal government’s power to regulate interstate commerce.

After a two-hour hearing with the parties, Judge Vinson indicated that he would likely deny the federal government’s motion to dismiss on at least the count addressing whether Congress can require most citizens to purchase health insurance.

For more information on healthcare reform and its impact on providers, please visit www.wachler.com or contact a Wachler & Associates attorney at 248-544-0888.

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According to a study by researchers at the National Opinion Research Center at the University of Chicago and Georgetown University, the number of doctors engaged in “concierge medicine” is on the rise.  The study found that almost 1,000 physicians nationwide practice concierge medicine.  Physicians with these types of practices offer enhanced services for patients, including longer appointments and increased availability.  In return, physicians request patients to provide retainers or additional costs for the services. 

There are many legal issues that must be considered when setting up a concierge medical practice.  If you need assistance with billing for concierge services or setting up a concierge medical practice, please contact the attorneys at Wachler & Associates at 248-544-0888.  
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The Office of the National Coordinator for Health Information Technology (ONC) named the first technology review bodies that are authorized to certify electronic health record (EHR) systems.  The review bodies, The Certification Commission for Health Information Technology (CCHIT) and the Drummond Group Inc. (DGI), will have the task of ensuring that EHR systems are in compliance with criteria set forth by the U.S. Department of Health and Human Services.  David Blumenthal, M.D., the national coordinator for Health Information Technology stressed that this is a “crucial step” as certified EHR systems will be required for providers to meet meaningful use standards and the healthcare community’s confidence will grow in these systems. 

This announcement comes as an important step in the Administration’s effort to encourage the transition from paper-based medical records to EHRs.  The Health Information Technology for Economic and Clinical Health (HITECH) Act created incentive payment programs to encourage healthcare providers to make this transition.  In order to qualify for the incentive payments, however, providers must adopt and demonstrate the meaningful use of certified EHR systems.  Now with CHIT and DGI, EHR systems can begin to receive certification and providers may begin to strive to demonstrate meaningful use of the EHR systems. 
For more information on the implementation of health information technology, obtaining incentive payments from CMS for the demonstration of meaningful use, or review of EHR contracts please visit www.wachler.com or contact a Wachler & Associates attorney at 248-544-0888. 
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The Department of Health and Human Services (HHS) announced on July 29 that it will make available $51 million in grants to help states initiate health insurance exchanges, mandated by the Patient Protection and Affordable Care Act.  Grants of up to $1 million will be made available to each state.  The purpose of the grants is to help states develop consumer-centered health insurance marketplaces that will encourage competition and greater control in the hands of individuals and small businesses.  The exchanges will be “one stop shops” for consumers and businesses to purchase health insurance coverage.

The HHS recognized the importance of the grants to encourage the implementation of the health insurance exchanges, given states’ struggles to maintain balanced budgets.  The Secretary of the HHS, Kathleen Sebelius voiced this concern by emphasizing that, “these grants will give [states] the resources to conduct the research and planning needed to build the health insurance marketplace of the future.”

States have the option to establish and operate their own exchange or partner with another state or states to operate a regional exchange.  Secretary Sebeilus said that if a state decides not to create an exchange for its residents, the HHS will establish one on their behalf.

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On June 11 we posted that the American Board of Internal Medicine (ABIM) had immediately suspended the board certifications of 139 physicians. Since that time, our office has submitted a series of written submissions and had other communications with the ABIM’s counsel in order to clarify that the “suspensions” were actually non-final recommended actions rather than immediate suspensions. In our June 18 blog entry, we announced that the notation, “Under Appeal – Suspension is not final” had been added to each of the affected physician’s entries on the ABIM website. Although this was a significant advancement, we remained concerned that ABIM’s language could cause irreparable damage to our clients’ staff privileges, employment agreements, fellowship programs and relationships with third party payors.

As a result of our efforts on behalf of our clients, last Friday (July 2), ABIM clarified the affected physicians’ entries on its website. Now these entries clearly state “Suspension Recommended” with the comment “Under Appeal – Suspension is not final.” We believe that this clarification will allow our clients to pursue their appeals without the threat of immediate loss of employment or loss of payor relationships. We are encouraged by this advancement and will continue to strive for a positive solution through communication with ABIM.

If you have received a notice of suspension by ABIM and would like assistance with the ABIM appeals process, please contact Andrew B. Wachler, Laura C. Range, or Alicia B. Chandler at 248-544-0888.

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As noted in our June 11 blog entry, the American Board of Internal Medicine (ABIM) recently took unprecedented action in immediately suspending the board certifications of 139 physicians. We have been in communication with the ABIM urging them to characterize the action as non-final recommended action pending appeal rather than an immediate suspension. Our intent is to avoid the irreparable impact that an immediate suspension will have on our clients’ staff privileges and relationship with third party payors. We have submitted legal support for this position, and we hope to work with the ABIM to effectuate a more reasonable and thought out solution.

As of today, the following notation has been added to each of the affected physician’s entries on the ABIM website: “Under Appeal – Suspension not final.” This is a significant advancement for all parties involved. We are hopeful that we will be able to effectuate a workable solution through further communication and the appeals process.

For more updated information, please visit the Wall Street Journal’s health blog.

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The American Board of Internal Medicine (ABIM) has filed suits against 5 physicians for alleged copyright infringement, the misappropriation of trade secrets, and breach of contract. In addition, ABIM immediately suspended or revoked a total of 139 physicians’ board certification. The ABIM is an organization that certifies internal-medicine specialists and sub-specialists. The organization alleges that the physicians solicited or shared confidential examination questions used to certify doctors in internal medicine and its subspecialties. The Wall Street Journal reported that the law suits stem from participation in Arora Board Review, an independent test review course. Last year, ABIM sued Arora alleging that Arora instructors told class participants that the review questions were from actual certification exams and encouraged them to inform the company of additional questions they remembered after taking the exam.

Our firm represents numerous physicians who have been affected by this unprecedented action. We are in the process of conducting a comprehensive evaluation of their legal rights regarding the suspension of their board certifications and individualized analyses of potential efforts to mitigate any collateral effects.

If you have been adversely affected by this lawsuit and would like assistance in evaluating your legal rights, please contact a Wachler & Associates attorney at 248-544-0888.

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St. Jude Medical Center will pay $3.7 million in a settlement with the Department of Justice regarding allegations that the organization paid illegal kickbacks to hospitals. In the settlement, St. Jude does not admit wrongdoing. The Department of Justice alleged that St. Jude paid kickbacks to hospitals in order to obtain opportunities in the heart device business. St. Jude argued that the allegations were based on “small, isolated product rebates “that had been paid over five years ago. The government argued, however, that these were kickbacks merely disguised as rebates. The case came to the attention of the Department of Justice through a whistleblower who had filed a False Claims Act qui tam action exposing the kickbacks. The whistleblower will receive $640,000 as part of the settlement.

If you would like any of your financial arrangements analyzed for risk of Stark or Anti-Kickback Statute violations, please contact a Wachler & Associates attorney at 248-544-0888.

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The sale of the Detroit Medical Center (DMC) to Vanguard Health System, a hospital chain based in Nashville, has been delayed ten days. The DMC Board of Trustees and Vanguard Health Systems extended the letter of intent to allow each organization’s legal teams to complete the necessary work for the parties to reach an agreement.

The proposed deal involves Vanguard’s investment of $850 million over five years in 20 projects, including a new tower at DMC’s Children’s Hospital of Michigan, and the expansion of the emergency department at Sinai-Grace Hospital. In addition, Vanguard would pay DMC $417 million to retire its debt and fund $278 million in pension obligations.

For more information on health law issues, please visit www.wachler.com or contact a Wachler & Associates attorney at 248-544-0888.

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