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According to a study by researchers at the National Opinion Research Center at the University of Chicago and Georgetown University, the number of doctors engaged in “concierge medicine” is on the rise.  The study found that almost 1,000 physicians nationwide practice concierge medicine.  Physicians with these types of practices offer enhanced services for patients, including longer appointments and increased availability.  In return, physicians request patients to provide retainers or additional costs for the services. 

There are many legal issues that must be considered when setting up a concierge medical practice.  If you need assistance with billing for concierge services or setting up a concierge medical practice, please contact the attorneys at Wachler & Associates at 248-544-0888.  
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The Centers for Medicare and Medicaid Services (CMS) recently published a new rule affecting Durable Medical Equipment (DME) providers.  The rule, effective September 27, 2010, strengthens Medicare’s standards for marketing and solicitations and expands enrollment requirements for DMEPOS providers.

Important highlights from the rule include:

– DME providers will be required to remain open to the public for at least 30 hours per week, except for physicians or licensed non-physician practitioners furnishing services to their own patients as part of their professional service and DME providers working with custom orthotics and prosthetics.

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The Detroit Medical Center (DMC) recently announced that it has saved more than $5 million in costs in 2009 due to its system-wide Electronic Medical Records (EMR).  This is the second consecutive year that the DMC has experienced cost-savings due to the EMR system. 

The system, which started to be implemented in 1998, cut costs by effectively preventing medication errors and monitoring important hospital tasks.  DMC leaders expressed enthusiasm not only for the cost-savings, but also for the improved quality of care for patients.  In the DMC press release, the DMC’s Chief Medical Information Officer, Dr. Leland Babitch, stated that the reduction in medication errors is “…a major gain for patients – especially given the fact that medication errors account for the majority of accidental deaths and injuries at U.S. hospitals.”
The DMC’s press release comes at a time when the Obama Administration is encouraging electronic health record (EHR) systems across the country.  For instance, the Office of the National Coordinator for Health Information Technology (ONC) recently named the first technology review bodies that are authorized to certify EHR systems. 
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The U.S. Department of Health and Human Services Office of Inspector General (OIG) recently issued two Advisory Opinions.  The first Advisory Opinion, AO 10-12, found that an arrangement between a grant program operated by a nonprofit, tax exempt charitable organization that provides grants to brain tumor patients who require financial assistance for the costs of drugs and/or devices would not result in civil monetary penalties (CMPs) even though the arrangement could cause prohibited remuneration under the Anti-Kickback Statute.

Although the funding for the grants comes from manufacturers of drugs and devices used to treat brain tumors and other conditions covered by the program, the OIG found sufficient safeguards in the system that mitigate the risk of improper influence.  First, the grant program will award assistance to beneficiaries based on objective criteria.  The assistance will not limit the patient’s ability to choose a provider, practitioner or supplier because the patient will have already made these choices prior to receiving the assistance.  In addition, no donor will exert control over the Foundation or affect the Foundation’s decision to award assistance.  Donors will not receive data that would allow it to determine the correlation between its donations and the use of its products or services.

In the second Advisory Opinion, AO 10-13, the OIG determined that it would not impose administrative sanctions for the provision of free insurance pre-authorization services because the arrangement included sufficient safeguards to reduce the risk that the free services would be inducements for referrals.  The proposed arrangement involved a hospital addressing requests from insurers for the pre-authorization of diagnostic imaging services before they are completed by the hospital.  The pre-authorization services would be provided by the hospital free of charge and without regard to the volume and/or value of any physician referrals.

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The Office of the National Coordinator for Health Information Technology (ONC) named the first technology review bodies that are authorized to certify electronic health record (EHR) systems.  The review bodies, The Certification Commission for Health Information Technology (CCHIT) and the Drummond Group Inc. (DGI), will have the task of ensuring that EHR systems are in compliance with criteria set forth by the U.S. Department of Health and Human Services.  David Blumenthal, M.D., the national coordinator for Health Information Technology stressed that this is a “crucial step” as certified EHR systems will be required for providers to meet meaningful use standards and the healthcare community’s confidence will grow in these systems. 

This announcement comes as an important step in the Administration’s effort to encourage the transition from paper-based medical records to EHRs.  The Health Information Technology for Economic and Clinical Health (HITECH) Act created incentive payment programs to encourage healthcare providers to make this transition.  In order to qualify for the incentive payments, however, providers must adopt and demonstrate the meaningful use of certified EHR systems.  Now with CHIT and DGI, EHR systems can begin to receive certification and providers may begin to strive to demonstrate meaningful use of the EHR systems. 
For more information on the implementation of health information technology, obtaining incentive payments from CMS for the demonstration of meaningful use, or review of EHR contracts please visit www.wachler.com or contact a Wachler & Associates attorney at 248-544-0888. 
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The RACs for Region D and Region C added medical necessity reviews to their lists of approved RAC audit issues.  HealthDataInsights (HDI), the RAC for Region D, added ten medical necessity reviews to its list of approved issues, while Connolly Healthcare (Connolly), the RAC for Region C, posted 18 medical necessity reviews involving 29 MS-DRGs.  The approvals of medical necessity reviews in RAC Regions D and C follow closely behind 18 medical necessity reviews recently approved by CGI, the RAC for Region B.  It is important to note that the “new” issues were included in sections already listed on HDI’s approved audit issues lists for review of DRG validations, whereas Connolly listed the medical necessity reviews as separate “new” approved issues.

For more information on RACs or if you need assistance defending a Medicare audit, please visit www.racattorneys.com or contact a Wachler & Associates attorney at 248-544-0888.

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Physicians Health Plan will be the insurer to offer subsidized health coverage for chronically-ill Michigan residents.  The insurer, based in Lansing, will offer health coverage through the health insurance pool that was created to provide an avenue for the uninsured chronically ill to buy coverage until state exchanges are active in 2014 as set forth in the health care reform legislation.  To qualify for the pool individuals must provide proof of U.S. citizenship and Michigan residency, certification by a physician that the individual is chronically ill and evidence that an insurer has refused, for health reasons, to cover the individual within the previous six months.  Physicians Health Plan will start enrolling members August 31 for coverage that becomes effective October 15. 

For more information on Michigan health care news or health care reform, please visit www.wachler.com or contact a Wachler & Associates attorney 248-544-0888. 

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The Detroit Free Press reported that a Michigan doctor was sentenced to 14 years in prison for Medicare fraud.  In addition to the prison sentence, the doctor will owe $9.4 million in restitution payments and is eligible for a three-year supervised release after his prison sentence.  According to the Department of Justice (DOJ), the doctor and a co-conspirator wrote prescriptions for controlled drugs in exchange for the patients’ Medicare numbers.  The co-conspirator would then bill for fictitious rehabilitation and home health services using the Medicare numbers.  Medicare reimbursed the conspirators $9.4 million for fake services.

For more information on Michigan healthcare legal news, or for assistance with a Medicare audit or investigation contact a Wachler & Associates attorney at 248-544-0888. 

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The Office of Inspector General (OIG) published two reports targeting inpatient rehabilitation facilities (IRF).  Most notable, however, is the CMS response to the OIG reports.  The first report reviewed IRF transmission of patient assessment instruments for calendar years (CY) 2006 and 2007.  This report showed that IRFs failed to timely submit patient assessment data and this could reduce the case-mix group payment. Based upon the OIG findings, CMS concluded that fiscal intermediaries (FI) overpaid IRFs approximately $20.2 million in CY 2006 and 2007.  Additionally, FIs may have overpaid $19 million because of a lack of clarity in the regulations regarding data for claims originally submitted within the 27-day timeframe, but then later resubmitted to correct errors outside the 27-day timeframe.

The second report addressed the issue of whether proper status codes were used on IRF claims.  When a patient is discharged to his or her home, Medicare pays the full prospective rate.  In contrast, if a patient is transferred from the IRF (to another IRF, a short-term, acute care prospective payment hospital, a long-term hospital or a nursing home that qualifies for Medicare or Medicaid payments), Medicare pays a reduced amount.  The OIG review found that out of 220 claims sampled, 213 claims were improperly coded as discharges.  This resulted in an overpayment of approximately $1.2 million.  For the four year period ending in September 2007, CMS determined the overpayments for this issue totaled approximately $34 million.  Of particular importance to IRFs is the fact that CMS has indicated that it will share the OIG audit information with the Recovery Audit Contractors (RACs) and encourage them to utilize the findings in their reviews.

For more information on Medicare audits, or for assistance with an audit, please visit www.racattorneys.com or contact a Wachler & Associates attorney at 248-544-0888.

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As part of the Patient Protection and Affordable Care Act (PPACA), i.e., health care reform, states received more than $46 million in grants from the U.S. Department of Health and Human Services (HHS).  Crain’s Detroit Business reported that Michigan has received $1 million of grants from HHS to go towards improving oversight and review of proposed health insurance premium increases.  Although the Michigan Office of Financial and Insurance Regulation (OFIR) will ultimately use the grant for this purpose, OFIR first must obtain additional legislative authority to enforce consumer protections in the federal bill.  This will require the Michigan Legislature to amend the Michigan Insurance Code to incorporate the specific consumer protections.  At this time, the OFIR only has the authority to review, investigate, examine and encourage compliance from health insurance companies. 

Crain’s Detroit Business also reported that Michigan plans to use the $1 million grant to:

(1) Contract with consulting actuaries for targeted, in-depth analysis and review of health insurance premium filings made by HMOs and commercial carriers.

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