Significant Health Law Developments

During the last twelve months, we’ve seen significant developments in health law. At today’s opening session of the annual meeting of the American Health Lawyers Association, we took stock of many of these developments, which include the following:

Medicare Cuts Saga Continues to Unfold.

On June 30th, we witnessed the latest chapter in the Medicare cuts saga, as President Bush issued a 10-day stay of the impending 10% reimbursement cuts. This move temporarily forestalls the reimbursement cuts until Congress returns from its July 4th holiday with a 3-day window to reach a compromise. For more information on these cuts, please see my earlier blogs

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NPI “Simplifies” Claim Submission, Causing Widespread Confusion throughout the Provider Community.

After multiple delays, the NPI mandate finally took effect last month. Remarkably, the average Medicare claim rejection rate skyrocketed from approximately 5% to 25%, due to the NPI mandate. (I am proud to report that MTBC’s clients have not experienced any increase in rejection rates as a result of its comprehensive, proactive NPI plan.)

The Feds Get Serious about HIPAA.

Following a decade of virtually no criminal HIPAA prosecutions, during the past year, we’ve seen three felony prosecutions. In U.S. v. Jackson, a hospital employee was indicted for selling Farrah Fawcett’s PHI to a tabloid. The defendant-nurse in U.S. v. Smith, pled guilty to unlawfully disclosing a patient’s PHI to her husband for use in a litigation matter. Finally, in U.S. v. Howell, an employee was indicted under HIPAA for disclosing PHI to a third party as part of an identity theft scheme.

Physician Report Cards Get an “F.”

As we recently discussed, we’ve witnessed a great deal of controversy regarding certain payers’ physician “report cards.” In New York, Attorney General Andrew Cuomo threatened to sue certain payers, alleging that their physician “report cards” did not (as the payers argued) measure quality, but instead were rigged to give high marks to those physicians who saved the payers’ money. This controversy resulted in a transparent, multi-tiered rating system that places a greater emphasis on quality – not simply cost – and is serving as a template for other payers.

More on Fraud and Abuse.

As we discussed earlier this year, the OIG issued its Self-Disclosure Protocol (SDP), which is aimed at encouraging providers to voluntarily disclose billing fraud and abuse, by assuring disclosers that their voluntary confessions will be met with lessened penalties. Moreover, Stark II, Phase III, provided additional rules regarding physician recruitment, rental arrangements and joint ventures.

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