March, April, May 2011
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The attorneys of the HLP regularly author articles in publications nationwide.  We invite you to read a selection of the articles we have published in March, April and May of this year regarding developments in healthcare law and what it can mean for your future business decisions.  As always, we encourage you to visit our website and our blog for timely guidance on regulatory developments and government actions, as well as contacting us directly by phone or e-mail to address your specific needs.

by Adrienne Dresevic, Esq. and Donald H. Romano, Esq., ABA Health Lawyer, April 2011.
In recent years, the Centers for Medicare & Medicaid Services ("CMS") has begun to place paramount importance on its ability to deny or revoke billing privileges as a means of protecting the Medicare program (the "Program") and its beneficiaries from fraud and abuse. The Patient Protection and Affordable Care Act ("PPACA") and the Healthcare and Education Reconciliation Act of 2010 (the "Reconciliation Act") greatly added to the enrollment-related weapons at CMS's disposal, and CMS has not lost any time implementing some of them. Unfortunately, because of the sheer number of enrollment rules, many of which are time sensitive, and because the enrollment process is largely implemented though CMS's contractors, whose procedures may not always be consistent with each other or those of CMS, even competent and ethical suppliers and providers can have their billing privileges delayed, denied, or revoked due to unintentional errors on their part (or on the part of the CMS contractors). This article explains the workings of the Medicare enrollment process, outlines the relevant provisions of PPACA and the Reconciliation Act, discusses the administrative appeals process for adverse enrollment actions, and offers some practical advice on preventing and resolving problems... Learn more>
It is no surprise that on March 31, 2011 the Centers for Medicare and Medicaid Services (CMS) released its long awaited Medicare Shared Savings Program proposed rule. The Shared Savings Program establishes financial incentives for forming accountable care organizations (ACOs) that meet certain efficiency standards with respect to Medicare services. CMS' development of the Proposed Rule revolved around its three-part aim for the Shared Savings Program: (1) better care for individuals, (2) better health for populations, and (3) lower growth in expenditures... Learn more>
On March 17, 2011, the Office of Inspector General (OIG) issued Advisory Opinion 11-02, which explained it would not impose sanctions on an acute care hospital's provision of complimentary transportation services. (This is the second advisory opinion on the issue; the first was issued on March 6, 2009--Advisory Opinion 09-01.) Subject to certain safeguards, the OIG determined that the proposed complimentary transportation arrangements did not pose a high risk for fraud, waste, and abuse... Learn more>
by Robert S. Iwrey, Esq., Michigan Medical Law Report, Spring 2011.
On February 17, 2011, 111 defendants were charged in 9 different cities with defrauding Medicare for more than $225 million, 21 of which are from the Detroit area--including 3 doctors, 3 physical therapists and 1 occupational therapist. This marked the largest coordinated Medicare fraud action ever taken. However, Michigan is no stranger to such actions in recent years. The Healthcare Fraud Prevention & Enforcement Action Team (a/k/a "HEAT") has been active in the Detroit area since March 2009. HEAT is an intra-agency effort between the Department of Justice ("DOJ") and the Department of Health and Human Services ("HHS"). HEAT was formed to build upon and strengthen existing programs to combat Medicare and Medicaid fraud, and invest resources and technology to prevent fraud, waste and abuse. Agents from the Office of Inspector General from the Department of Health and Human Services (OIG), the DOJ, the Federal Bureau of Investigations (FBI), the Drug Enforcement Agency (DEA), and other federal and local law enforcement agencies have shared information and resources to investigate and prosecute fraudulent health care matters in both the criminal, civil and administrative realms. Medicare Fraud Strike Forces have had considerable success in detecting and examining potentially fraudulent activity and recovering money from those found guilty... Learn more>
by Abby Pendleton, Esq. and Jessica L. Gustafson, Esq., Michigan Medical Law Report, Spring 2011.
Physicians are facing unprecedented scrutiny in the submission of claims. For example, with respect to Medicare claims, not only do Medicare Affiliated Contractors ("MACs") (or Medicare Carriers and Intermediaries) conduct their own audits, but also Medicare's Recovery Audit Contractor program is now operational nationwide (and has recently been expanded to include Part C and Part D claims), and Zone Program Integrity Auditors ("ZPICs") (or Program Safeguard Contractors ("PSCs")) are conducting nationwide benefit integrity audits. With respect to Medicaid claims, Medicaid Integrity Contractors ("MICs") are actively auditing claims, and the RAC program is expanding to Medicaid claims as well. Physicians must be cognizant of this increased claims scrutiny and conduct themselves accordingly, with an increased focus on compliance. Notably, certain compliance issues are heightened with the use of electronic medical records. This article will set forth compliance recommendations for physician practices, with a particular focus on the compliance issues raised by electronic medical records... Learn more>
co-authored by Adrienne Dresevic, Esq. and Stephanie P. Ottenwess, Esq., Radiology Management, March/April 2011.
The mere mention of the term "tort reform" is enough to evoke great passionate response from its myriad proponents and detractors.  For the past three decades, medical malpractice tort reform has remained a highly polarizing, heavily contested legal issue which affects not only physicians and attorneys, but also the great many Americans seeking healthcare each year. But why does this legislation inspire such fervency in those that revile it and in those that champion it? Ask its critics, which typically include much of the plaintiffs' bar, and the answer is simple: medical malpractice tort reform strips individuals of their ability to redress injuries that they have incurred and right the perceived wrongs that have been committed against them. To its advocates, the answer is equally clear: medical malpractice tort reform is the mechanism by which defensive medicine is prevented, doctors' personal and professional livelihoods are protected and litigious plaintiffs with frivolous lawsuits are deterred from bringing suit. While both sides make convincing arguments, the reality of medical malpractice tort reform lies somewhere in the middle... Learn more>
We have extensive experience with RAC audits and appeals, working directly with healthcare entities subject to RAC audits.
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March, April, May 2011
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