Doctors Going to Jail for Medicare Scams
The month of June has been flush with medical professionals heading to jail for Medicare fraud.
Most recently, a Miami-Dade county doctor, Dr. Rene de los Rios was given a lengthy 20 year sentence for his participation in a Medicare fraud scheme. Dr. de los Rios falsified hundreds of patient records to the tune of $46.2 million for HIV therapy. Many of his patients received kickbacks. While, Dr. del los Rios' attorney argued for a shorter sentence (given his client's 72-years of age), the U.S. District Judge refused and instead chastised Dr. del los Rios for violating his medical oath, stealing from the vulnerable government program, and disgracing himself. Read More ›
Categories: Fraud & Abuse, Physicians
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First Appellate Holding: PPACA is Constitutional
On June 29, 2011, the 6th Circuit Court of Appeals issued the first appellate decision with regard to the constitutionality of the Patient Protection and Affordable Care Act ("PPACA"). In a split decision (2-1), the court upheld the minimum coverage provision of PPACA (also know as the 'individual mandate') as constitutional. The individual mandate essentially fines non-exempt persons for not securing minimum essential health insurance coverage. The court noted that this provision was effectively a regulation on the practice of self-insuring (an individual's actions in arranging his or her own financial affairs to compensate for future health care needs). Read More ›
Categories: Health Care Reform, Insurance
EHR Incentive Program Updates
According to the Centers for Medicare & Medicaid Services ("CMS"), CMS has already paid $75 million to health care providers for meaningful use of electronic health records ("EHR") since the first incentive payments began in mid-May, 2011. This number is only expected to rise as physicians and hospitals have until the end of 2012 to attest to "meaningful use" of EHR and become entitled to receive the maximum amounts over a five-year period. Read More ›
Categories: News
CMS Recognizes Additional Hardship Categories for Electronic Prescribing Waivers
On June 1, 2011, the Centers for Medicare & Medicaid Services ("CMS") issued a proposed rule that would allow certain physicians to avoid having to use electronic prescribing ("eRx") by the required June 30, 2011 date.
Currently, CMS requires that providers complete at least 10 drug orders using an eRx system between January 1 and June 30, 2011 in order to avoid a one percent decrease in Medicare payments in 2012. Prior to the June 1, 2011 proposed rule, only rural providers with limited internet access or providers in an area with limited pharmacies for eRx could claim a hardship waiver to avoid the penalties for failing to make the 10 eRx orders. Read More ›
Categories: News
First Electronic Health Record Incentive Payments To Be Issued However Few Are Able to Exchange Information as Required
The Office of the National Coordinator for Health Information Technology ("ONC") announced that the first electronic health record ("EHR") incentive payments were going to be made in mid-May to providers who had successfully attested to having met "meaningful use" and all of the other program requirements. The maximum payment that a Medicare provider in the EHR program can receive in 2011 for his or her first year of participation is $18,000. Incentive payments for eligible hospitals begin at $2 million. Read More ›
Categories: Technology
CMS Discarding Unanswered FOIA Requests
The Centers for Medicare and Medicaid Services ("CMS"), like other federal agencies, generally has 20 days (plus a 10 day extension) to respond to requests for information under the Freedom of Information Act ("FOIA"). However, CMS responses seem to take quite a bit longer.
Last week, I received a response to a FOIA request that I filed with CMS in March of 2010. That's right: 2010. In its response, CMS explained that when it is busy, it utilizes a "first-in, first-out" approach when responding to requests. Read More ›
Categories: Hospitals, Physicians, Regulatory
Michigan Supreme Court Issues Decision on Small Employer Group Health Coverage
Small employers may soon expect to see provisions in their health plan policies requiring them to make minimum contributions to their employees' premiums as a result of a recent Michigan Supreme Court decision. On May 17, 2011, the Supreme Court of Michigan rendered a decision interpreting a provision in the Small Group Health Coverage Act (the "Act"), a law that requires every insurance carrier wishing to provide health care benefits to small employers in Michigan to offer all of its small-employer health plans to all small employers. MCL 500.3701 et. seq.
Categories: Billing/Payment, Employment, Insurance
Braving the New Frontier of Accountable Care Organizations
On May 17, 2011, the Center for Medicare and Medicaid Innovation, a part of the Centers for Medicare & Medicaid Services ("CMS"), announced a "Pioneer ACO Model" designed for providers that are already experienced in coordinating care for patients across care settings.
The Pioneer ACO program provides higher risks and greater rewards in the first two years of the program than those available to non-Pioneer Accountable Care Organizations ("ACOs"). Specifically, non-Pioneer ACOs can choose from two tracks that vary on risk and reward under the CMS proposed ACO regulations. Track One ACOs are those involved in a “one-sided model” that begins as a no-risk shared-savings payment system for the first two years and converts to a risk-sharing payment system in the third year. Track Two ACOs are those that are involved in a "two-sided model,” with risk-sharing (of both savings and losses) beginning in year one. Pioneer ACOs also participate in two-sided risk sharing from year one. Read More ›
Categories: Accountable Care Organizations, Health Care Reform, Hospitals
Exchange Planning In Michigan Health Insurance
The 2010 health reform act, the Patient Protection and Affordable Care Act ("PPACA"), provides for the creation of health insurance "exchanges." Exchanges are programs designed to make it easier for eligible consumers and small businesses to compare and purchase health insurance coverage in a one-stop shopping format. An Exchange is essentially a set of state regulated and standardized private health care plans, from which individuals may purchase health insurance that is eligible for federal subsidies. States choosing to create Exchanges are required to have them up and running by 2014. Read More ›
Categories: Health Care Reform, Health Insurance Exchange, Regulatory
The Government is paying HOW much?
The Medicare Data Access for Transparency and Accountability Act ("DATA Act") was introduced in the United States Senate on April 7, 2011. The DATA Act seeks to make public the Department of Health and Human Services' claims and payment data, which would include data on payments made to medical providers pursuant to the Social Security Act (i.e., Medicare). Specifically, the data made available to the public would include the following: Read More ›
Categories: Billing/Payment, Medicare/Medicaid
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Best Lawyers® 2021
Congratulations to the attorneys of the Health Care practice group at Foster Swift Collins & Smith, PC for their inclusion in the Best Lawyers in America 2021 edition. Firm-wide, 44 lawyers were listed. Best Lawyers lists are compiled based on an exhaustive peer-review evaluation and as lawyers are not required or allowed to pay a fee to be listed; inclusion in Best Lawyers is considered a singular honor. Health Care practice group members listed in Best Lawyers are as follows:
- Jennifer B. Van Regenmorter, Holland
To see the full list of Foster Swift attorneys listed in Best Lawyers 2021, click here.