Posts tagged Affordable Care Act
U.S. Supreme Court Opens New Term with Health Care Storm Looming Overhead
Oct 3rd
The U.S. Supreme Court term opened today with expectations that the Justices will rule on the numerous legal questions surrounding the federal health care reform. Although not formally on the docket, most experts believe that the constitutional challenge to President Obama’s health care overhaul almost certainly will be decided this term.
Since the Affordable Care Act was passed, dozens of federal lawsuits seeking to overturn it have been filed. Appeals courts have ruled on five such challenges and two more currently await appeals courts rulings. The Act remains a political lightning rod with GOP presidential contenders using virtually every debate and speech to criticize it.
The nine justices of the Supreme Court, who serve without seeking election, will have to decide whether to insert themselves into the center of this political maelstrom. But, the Obama administration’s request last week that the justices resolve whether the health care law is constitutional makes it more likely than not that the Court will deliver a verdict by June 2012, just as the Presidential race charges toward the fall campaign.
If as now expected the justices agree to review the law’s constitutionality, those deliberations would certainly define the court’s coming term. Their decision could rank as the court’s most significant since the December 2000 ruling that effectively sealed George W. Bush’s election as president.
Christine Salimbene, Vice President & General Counsel
Ms. Salimbene joined MTBC in 2009 as General Counsel, Vice President and Company Secretary. She and her team focus on mitigating business risk and ensuring compliance with all legal requirements.
Affordable Care Act Rules to Prevent Fraud: How Increased Vigilance Will Affect Your Practice
Aug 17th
If you are wondering how the new healthcare law – the Affordable Care Act – will affect your practice, you are not alone. Providers across the country are trying to understand the implications that this new law will have on reimbursements and the practice of medicine. Well, because the public is clamoring for my opinion on this matter, I will embark on a series of blog posts dedicated solely to the different provisions of the Affordable Care Act. You’re welcome.
One of the most important features of the Affordable Care Act is the increased measures designed to weed out fraud and abuse in the healthcare system. Whatever your opinion on this new law is, we can all agree that prosecuting and preventing healthcare fraud is a noble goal. In keeping with the spirit of preventive care in the Affordable Care Act, the anti-fraud measures of the law focuses on the prevention of fraud by identifying and remedying the sources of abuse. We have yet to see the law in full action but a reading of the statute appears to combat fraud with a broad stroke. For example, the law includes the following:
More detailed credentialing process- CMS will be scrutinizing Medicare, Medicaid and the new Children’s Health Insurance Program (“CHIP”) provider applications a little more closely to prevent fraud from even occurring. To this end, CMS states that certain types of providers (read- DMEs and “Pain Management”) will receive special attention.
New enrollment process for Medicaid and CHIP- Each individual State will be responsible for screening providers for enrollment in Medicaid and CHIP. The States will be on the lookout for providers who have been excluded from Medicare or another State’s Medicaid program. If this evidence is discovered, the provider will be barred from enrollment in Medicaid and CHIP in any State.
Temporary stop of enrollment if patterns of fraud are detected- Medicare will be borrowing new strategies from the credit card industry to identify patterns of fraud. If a pattern is discovered, all provider enrollment will be stopped until the fraud is remedied. Providers can be affected due to their geographic location or type of practice.
Payments stopped during investigation- If there is a “credible allegation of fraud”, CMS will stop all payments to a provider during the investigation process. The investigation process could take several months and would be a disaster for a practice alleged to have committed fraud.
Although these features of the new healthcare law are designed to prevent wide scale abuse of the healthcare system, they are broad and aggressive enough to potentially affect honest providers. Remember that laws are like cobwebs, which may catch small flies, but let wasps and hornets break through. Therefore, it is wise for your practice to understand these new anti-fraud countermeasures and how they could potentially affect your practice.
Thanks for reading and be sure to continue to follow my posts on the Affordable Care Act.
If you would like more information, check out CMS’s website at http://www.hhs.gov/news/press/2011pres/01/20110124a.html.
Brendan P. Harney, Associate General Counsel
Mr. Harney joined MTBC in 2010 as an Associate General Counsel. His practice mainly focuses on healthcare compliance regulations including HIPAA and state privacy laws.
Affordability: The Future of Health Insurance
Aug 15th
The Departments of Health and Human Services and Treasury have taken the next steps in establishing Affordable Insurance Exchanges – State-based competitive marketplaces, which launch in 2014, designed to provide individuals and small businesses with access to one-stop marketplaces where they can choose a private health insurance plan that fits their needs and offers the same kind of insurance choices as members of Congress.
This past Friday, HHS awarded $185 million to 13 states and the District of Columbia to help them build the Exchanges and, with Treasury, posted three proposed rules that will provide a simple, streamlined, and affordable path for consumers to use the Exchanges to purchase private health insurance. The proposed rules describe how middle-class families will gain access to unprecedented tax relief that will dramatically reduce the cost of coverage.
The Affordable Care Act, which President Obama signed into law on March 23, 2010, creates the Exchanges. More than half the states have already taken action to begin building an Exchange and the new grant awards will accelerate that progress. The Exchange Establishment grants awarded today build on earlier investments in states. In 2010, HHS awarded 49 states and the District of Columbia $50 million to begin planning their Exchanges. HHS expects to make more grant awards in coming months.
Christine Salimbene, Vice President & General Counsel