Articles Posted in Health Law

Yet another way that the Patient Protection and Affordable Care Act (the Act), otherwise known as the Health Reform bill, impacts health care providers is the strengthening of the Federal False Claims Act (FCA).

For example, Section 6402 of the Act amends Section 1128 B of the Social Security Act to expressly define services performed or billed in violation of the anti-kickback statute as false claims: “…a claim that includes items or services resulting from a violation of this section constitutes a false or fraudulent claim…”

In addition to the reinforcement of false claims liability for anti-kickback violations, Section 6402 establishes deadlines for repaying health care overpayments. Failure to meet the deadlines causes providers to be in violation of the FCA’s “reverse false claims” provision. The deadline for reporting and returning overpayments is the later of 60 days after the date the overpayment is identified, or the date any corresponding cost report is due, if applicable.

The U.S. Department of Health and Human Services awarded the Michigan Department of Community Health (MDCH) and the Michigan Department of Information Technology (MDIT) a $14.9 million grant to encourage the expansion and success of health information technology (HIT) in Michigan.

The funds, provided through the American Recovery and Reinvestment Act of 2009, will be used to create the first statewide HIT network and increase the state’s use of HIT. The state’s goal is to increase the accessibility to individual patient records and healthcare information.

To reach these goals, the state will use the grant to implement the technological infrastructure to coordinate local and regional health information exchanges, health systems, state of Michigan systems, and integrated delivery networks. Once the system is in place, healthcare providers will be able to effectively communicate and share information, increasing healthcare quality and patient safety while reducing healthcare costs.

A New York Times article from March 15, 2010, documents the most serious problem with cuts to Medicaid payments to doctors: doctors dropping out of the program. The article focused on doctors in and around Flint, Michigan.

According to the article, in 2008 Medicaid reimbursements averaged only 72 percent of the rates paid by Medicare. Michigan, at 63 percent, had the sixth-lowest rate in the country. However, that low ranking does not even take into account the 8 percent Medicaid payment cut implemented last fall in Michigan.

To add to the strain on doctors that accept Medicaid, Michigan’s Governor Jennifer Granholm, has revived a proposal to impose a 3 percent tax on physician revenues. Without the tax, the Governor has warned that the state may have to reduce Medicaid payments by 11 percent.

For the first time, Michigan providers must charge patients less than the previous year for copies of medical records. The Michigan Medical Access Act of 2004 regulates the access to and disclosure of medical records. Under the Act, the Department of Community Health has the responsibility to adjust on an annual basis the fees that may be charged by a Michigan provider to any patient requesting copies of medical records. The adjustment is based on the Detroit Consumer Price Index. This year, for the first time the fee has been decreased from the previous calendar year. In CY 2009, the initial fee for copies was $22.08, but in CY 2010, the initial fee is $21.95.

For more information, please visit www.wachler.com or contact a Wachler & Associates attorney at 248-544-0888.

A final rule published by the Department of Health and Human Services expanded the scope of the National Practitioner Data Bank to now include disciplinary information on all licensed health care professionals, including nurses, podiatrists, chiropractors, and physician assistants. Prior to this new rule, the databank, established under the federal Health Care Quality and Improvement Act of 1986, collected adverse findings only against physicians and dentists by state licensing agencies and credentialing bodies. Similar information involving other health professionals was collected in a separate reporting database.

Please see the attachment to read the final rule.

For more information, please visit www.wachler.com or contact a Wachler & Associates attorney at 248-544-0888.

On February 19, Michigan Governor Jennifer Granholm issued an Executive Order creating an independent Office of Health Services Inspector General (OHSIG) within the Department of Community Health. The Executive Order will become effective on October 1, 2010. Governor Granholm will have the responsibility to appoint the Health Services Inspector General.

The OHSIG will further the state’s fight against fraud by consolidating the responsibilities into one independent office. According to the Governor, this will ensure that the office will be able to focus on specific auditing and fraud prevention goals. The Executive Order grants the Inspector General’s Office with broad powers to carry out these tasks.

For more information, please visit https://www.wachler.com/ or contact a Wachler & Associates attorney at 248-544-0888.

On January 5, 2010, Governor Jennifer Granholm signed legislation that expands the chiropractic scope of practice in the state of Michigan. The expansion is designed to restore the scope of practice that existed prior to when the Public Health Code was rewritten. Chiropractors in Michigan may now treat neuromuscular, skeletal and joint disorders throughout the entire body.

The Public Health Code now defines the “Practice of Chiropractic” as the discipline within the healing arts that deals with the human nervous system and the musculoskeletal system and their interrelationship with other body systems. The scope of practice also now includes the diagnosis of conditions and disorders of the human musculoskeletal and nervous systems as they relate to subluxations, misalignments, and joint dysfunctions. To evaluate the conditions or symptoms related to these conditions, a chiropractor may order advanced radiology scans if those scans were within the scope of practice as of December 1, 2009.

For more information, please visit www.wachler.com or contact a Wachler & Associates attorney at 248-544-0888.