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Akerman’s Health Law Rx Blog
I am pleased to announce my firm’s new health law blog, Health Law Rx Blog.
Akerman’s Health Law Rx Blog provides timely updates on the latest health law issues, keeping the firm’s clients, friends, and readers up to date on pertinent legal developments. Akerman attorneys regularly update the blog with changes in the law and other relevant news. As this is meant to be an interactive site, your comments and contributions are appreciated. I am one of the contributors, so I hope you will visit the blog often and participate in any discussions that interest you. I plan to shadow post articles from the blog that I think you will find interesting.
Content on Akerman’s Health Law Rx Blog is intended to inform you about legal developments, including recent decisions of various courts and administrative bodies. It should not be construed as legal advice or a legal opinion, and you should not act upon the information without seeking the advice of legal counsel.
With more than 550 lawyers and government affairs professionals and a network of 19 offices, Akerman is ranked among the top 100 law firms in the U.S. by The National Law Journal NLJ 250 (2012). The firm’s Healthcare Practice Group includes over twenty attorneys and professionals representing health systems, physicians, health insurers, and other clients in all aspects of healthcare law across Florida and throughout the United States.
Immigration reform could add millions of people under Obama health law – The Hill’s Healthwatch
Comprehensive immigration reform could make millions of people suddenly eligible for assistance under President Obama’s healthcare law, assuming a final deal paves the way for undocumented immigrants to receive papers.
Illegal aliens are now prohibited from purchasing coverage through the Affordable Care Act’s insurance exchanges, which will launch next year.
They are also ineligible for Medicaid under most circumstances, making the law’s expansion of the program fruitless for people without documents.
The landscape could change completely if Hispanic lawmakers get their wish — an overhaul of U. S. immigration policy that includes a path to legalization.
Helping people get and stay healthy, illegal immigrants or not, has to be cheaper in the long run. Sort of like Stephen Covey’s “sharpening the saw” — it takes time and resources to sharpen the saw, but once done, the work goes easier.
See on thehill.com
Health Care Law Delivers Higher Payments to Primary Care Physicians
CMS, in a press release on Thursday, November 1, announced the adoption of the final rule implementing the part of the Affordable Care Act that primary care physicians be paid 100% of the Medicare rate when they treat Medicaid beneficiaries. The final rule is over 100 pages long and provides —
Under this provision, certain physicians who provide eligible primary care services will be paid the Medicare rates in effect in calendar years (CY) 2013 and 2014 instead of their usual state-established Medicaid rates, which may be lower than federally established Medicare rates. The payment increase applies to primary care services delivered by a physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine or related subspecialists. States will receive 100 percent federal financial participation (FFP) for the difference between the Medicaid state plan payment amount as of July 1, 2009, and the applicable Medicare rate.
The rule provides information about how CMS and states will work together to make the increased payments operational. More information can be found in the CMS Fact Sheets.
GWU Face the Facts: Medicaid covers nearly half the 1.2 million Americans getting regular treatment for HIV – 47%
Nearly 1.2 million Americans get regular treatment for HIV, and Medicaid covers almost half of them – 47 percent. Only 1 percent of Medicaid clients have HIV; their care consumes 2 percent of the Medicaid budget ($5.3 billion). They represent 23 percent of all HIV-infected people in the U.S; not all those infected are receiving treatment.
African-Americans are at particular risk for HIV. Half of Medicaid HIV patients are African-American, and the CDC estimates new HIV infections run six times as high among African-Americans as for white men.
See on facethefactsusa.org
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
From HMOs to ACOs: Meet the newest model in health care management – TwinCities.com
When critics look at health care in America, many describe a system that’s fragmented, inefficient and burdened with waste.
Doctors and hospitals generally are paid a fee for every service they provide, the critique goes, so they lack financial incentives to effectively coordinate care and make sure patients get only the services they need.
Patients often have a front-row seat on the dysfunction, critics say, as they are shuffled off to specialists without needed paperwork, undergo unnecessary tests or make repeat hospital visits when medical centers don’t get it right the first time.
Enter “accountable care organizations,” a new structure in health management that the federal government, health insurers and some physicians hope will tame the woes. Doctors, hospitals and clinics would be given responsibility to provide care for a group of patients — within a budget. If health care providers better coordinate care to provide good quality for less money, they can share in the savings.
Republicans and Democrats “agree that transitioning from fee for service to global payments in health care will be necessary in order to deal with the budget deficit,” Bottles wrote in an email. “The consolidation of the health care industry will continue no matter which party prevails in the November election.”
This push for accountable care organizations (or “ACOs”) is driving a consolidation trend among health care companies that’s increasingly being felt in Minnesota. The clearest example is a plan announced in August to combine the HealthPartners and Park Nicollet health systems into one of Minnesota’s largest nonprofit health companies, with 20,000 employees, including 1,500 physicians.
See on www.twincities.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Louisiana Couple sentenced in Medicare fraud case
A Plaquemine couple is headed to federal prison after admitting that they used their medical equipment company to defraud Medicare of slightly more than $1 million.
The couple admitted they billed Medicare for equipment that was either medically unnecessary or never delivered to Medicare beneficiaries. In some cases, Medicare was billed for expensive equipment for which inferior products were substituted.
Between January 2006 and March 2008, according to their charge, the Stewarts and “others known and unknown to the United States attorney” falsely billed Medicare for $1.9 million in power wheelchairs, orthotics and other durable medical equipment.
See on www.fox8live.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
A Harsh Reminder of How Active the OIG, DOJ, and State AGs are in Health Fraud Prevention
A harsh reminder to healthcare providers that the OIG, DOJ, and state AGs are actively prosecuting healthcare fraud.
See on oig.hhs.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Report faults Medicaid patient cost in New York’s residential centers for the developmentally disabled
ALBANY — New York’s residential centers for the developmentally disabled cost Medicaid about $1.9 million a year for each patient, and federal overpayments that total $15 billion since 1990 should end immediately, according to a congressional oversight committee.
In a report this week, the House Committee on Oversight and Government Reform said the overpayments represent “massive waste,” are likely illegal and should stop immediately. The report also faulted lax oversight.
“Overwhelming evidence suggests that the federal government has failed to question New York state’s excessive developmental center payment rates adequately,” the report said. “Given the extraordinarily dire federal budget situation, the Center for Medicare and Medicaid Services’ failure to prevent the massive Medicaid overpayments flowing to New York state’s developmental centers needs to be corrected immediately.”
See on www.timesunion.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Program for ‘medically fragile’ kids in Illinois hanging on despite threatened cuts
MARQUETTE HEIGHTS — The little boy jumping in the middle of the bed, screeching out his favorite song, “Play that Funky Music White Boy,” has congenital central hypoventilation syndrome, a gene mutation that causes his body to forget to breathe.
The rare disease is also the reason 5-year-old Alex has had a tube sprouting from his windpipe since he was 6 weeks old and a bedroom that doubles as a hospital room. But right now, it is not the rarity of Alex’s disease that concerns his parents. It’s Illinois’ effort to reduce wide-ranging Medicaid costs, his father says, at the expense of children like Alex who rely on medical technology and round-the-clock nursing care to live at home.
Bill and Holly Thompson are among some 500 families throughout the state who depend on what’s called the MFTD waiver, or the Medically Fragile and Technology-Dependent Waiver program.
With the waiver, their children are eligible for Medicaid regardless of parental income. Without it, parents can’t afford the round-the-clock nursing care — at an average cost of $188,000 a year — their children require to avoid institutionalization.
MFTD-waiver families have popped up as one of the most vociferous grass-roots groups fighting specific changes in the state’s Medicaid reform package. So far, families have played a role in blocking state plans to shift more of the costs to families, impose income eligibility caps and change standard-of-care definitions. They’ve cornered Julie Hamos, head of the state Department of Healthcare and Family Services, at public forums and filed a lawsuit to stop the changes.
The federal Centers for Medicare and Medicaid Services stepped in, asking state officials to request a deadline extension so federal officials would have time to review the changes. An initial Sept. 1 deadline has been extended 90 days.
Families no longer eligible for the waiver would face huge out-of-pocket expenses with no transition plan. Some say they’d have to quit their jobs, work part time or divorce to make sure their children get the proper care. Or their children might be forced to move into a nursing home, which would cost Medicaid three times as much as the waiver program.
See on www.sj-r.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Texas Tribune — Proposed Medicaid Fraud Rules Worry Providers
The state’s Health and Human Services Commission is seeking formal approval for new Medicaid fraud rules that doctors allege deny them due process and expand investigators’ power to halt their funding.
For months, HHSC’s Office of the Inspector General has been increasingly relying on a federal rule — part of President Obama’s health care plan — that allows the agency to freeze financing to any health provider accused of overbilling Medicaid. That means they can halt the flow of funding before they complete a full-fledged investigation, and often, providers say, before doctors are given any chance to defend themselves.
HSC says the new state rules — a rewrite of the existing statute — give investigators the tools to stop the bleeding before bad actors run off with the state’s money. They say fraud investigations aren’t opened without good reason, and the idea that there’s no due process is preposterous.
The agency says the new rules, which must be approved by the executive commissioner, are necessary to bring the state in line with federal health reform and measures passed in the last legislative session. It is “mostly a clean-up of the existing rules,” agency spokeswoman Stephanie Goodman said.
But attorneys for health care providers, who are still trying to parse the rewritten rules, say the language the state is preparing to codify appears to put even more power into investigators’ hands than what they’ve already received from the federal government.
See on www.texastribune.org
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Joseph Rugg's Health Law Blog 