Hot Topics In Health Law
Law Student Reviews:
“Medicare Payment Reform: Accelerating the Transformation of the US Healthcare Delivery System and Need for New Strategic Provider Alliances”
By Maria T. Currier, Esq., Holland & Knight, Miami, FL and Morris H. Miller, Esq., Holland & Knight, Tallahassee, FL
Review by Daniel Eliav, Loyola Law School, Los Angeles, Class of 2011
Medicare payment reforms signal an unprecedented shift in the delivery of healthcare. The reforms include bundling Medicare payments for acute care with payments for post-acute and physician services, the use of accountable-care organizations (“ACOs”), the development of medical home delivery models, and shared savings arrangements. Providers must begin to address organizational and legal considerations created by these reforms as an integral part of their strategic planning.
Under CMS’s current fee-for-service payment system, providers focus on more care, more intensive care, and more expensive care. In the coming years, CMS is transforming into an active purchaser of care forcing providers to focus on higher quality, favorable outcomes, and reduced costs. Read More
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“2009 Healthcare law Enforcement “Perfect Storm”
By Michael J. Vanselow, Esq. and Ann M. Bildtsen, Esq., Oppenheimer Wolff & Donnelly, Minneapolis, MN
Review by Raquel Spencer, University of Illinois College of Law, Class of 2012
2009 saw a renewed focus on attacking fraud, record recoveries and penalties, an increase in resources and legal weapons, and a more aggressive enforcement of healthcare fraud related laws. Such a climate has affected various healthcare sectors and players including insurers, providers, prescription drug and medical device makers, durable medical equipment (“DME”) suppliers, and healthcare service recipients. This surge of intense healthcare law enforcement activity has culminated in a “Perfect Storm” for the healthcare industry.
Government effort to crackdown on fraud, waste, and abuse in its healthcare programs is at an all-time high, and is focused on fraud committed by home healthcare, pharmacies, and DME suppliers. In 2009, the overall fraud recoveries under the federal False Claims Act far exceeded its 2008 recovery and was largely generated by healthcare fraud enforcement. Read More
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“Medical Lease Primer ”
By David L. Haron, Esq. and Suzanne D. Nolan, Esq., Frank, Haron,Weiner & Navarro, Troy, MI
Review by Erin N. Lau, Loyola University of Chicago School of Law, Class of 2012
David L. Haron, Esq. and Suzanne D. Nolan, Esq. wrote a very informative and detailed article on medical leases in the February issue of The Health Lawyer. They accurately and unquestionably showed that medical office leases are different from standard commercial office leases. Medical office leases must comply with Stark law and the Anti-kickback Statute, which are unique to medical office leases. The purpose of these laws is to prevent healthcare providers from receiving payments based on the “volume and value of referrals of patients for certain healthcare items or services payable by a federal healthcare program.”
Under Stark, unless there is an exception, a physician or a physician’s immediate family member that has a specified financial relationship with an entity then that physician may not make referrals to the entity for DHS. An entity is a provider or supplier that furnishes DHS to a patient pursuant to a physician’s order and submits a claim to Medicare for the DHS. Stark issues arise when the landlord is a healthcare provider, such as a hospital, and the tenants are physicians or physician organizations. An example would be a physical therapist that practices in an office space owned by a hospital, the physical therapist must meet an exception of Stark should it refer a patient to that hospital. Read More
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