Health Care Law Blog

US Supreme Court Receives Health Reform Challenge

In the race to the top, the 6^th Circuit decision upholding the constitutionality of the Patient Protection and Affordable Care Act ("PPACA") is the first to come before the United States Supreme Court.  In response to the 6^th Circuit's adverse ruling against it (discussed here), the Thomas More Law Center, et. al., recently petitioned the Supreme Court for review.

The Petition specifically presents two questions for consideration by the Supreme Court: Read More ›

Categories: Health Care Reform, Insurance

Posted by: Mindi M. Johnson

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US Supreme Court Protects the Free Speech of Pharmaceutical Detailers

The US Supreme Court recently delivered a victory to data miners and pharmaceutical manufacturers in a June 23, 2011 decision, which held that a Vermont statute was an unconstitutional restriction of free speech rights.  In William Sorrell v IMS Health, Inc., 564 US --- (2011), the Court reviewed a Vermont statute that prohibited the use of prescriber-identifiable information (details of a physician's prescription practices) for marketing or promoting a prescription drug.   The statute was intended to target the practice of "detailing" a pharmaceutical representative's use of a particular physician's prescribing history to tailor a sales pitch to that physician in an effort to persuade him or her to prescribe certain (high profit or brand name) drugs.  Because various Circuit Courts of Appeal had reached opposite conclusions on the constitutionality of similar statutes, the United States Supreme Court agreed to hear the case. Read More ›

Categories: Physicians

Posted by: Mindi M. Johnson

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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 6^th 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

Posted by: Mindi M. Johnson

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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

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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

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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

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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

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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. 

For a complete analysis of this case, see our newsletter article entitled "Michigan Supreme Court Issues Decision on Small Employer Group Health Coverage."

Categories: Billing/Payment, Employment, Insurance

Posted by: Jennifer Kildea Dewane

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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

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