ABA Health eSource - Your link to the ABA's Health Law Section

Special Edition PPACA

 July 2010
Health Law Section News  July 22, 2010

July 27, 2010
Advanced Peer Review - The Hot Topics in Detail
(CLE Teleconference)

July 29, 2010
Mental Health Parity: What the Future Holds for Health Insurance Coverage of Mental Health and Addiction Treatment Services
(CLE Teleconference)
August 3, 2010
The New HIPAA/HITECH Regulations: What's New and What Does It Mean for You?
(CLE Teleconference)
August 18, 2010
Screening for Excluded Persons and the New PPACA Refund Requirement
(CLE Teleconference)

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PPACA Special Edition for July

Due to the enormous impact of the Affordable Care Act, the ABA Health Law Section’s eSource Editorial Board has decided to create a series of Affordable Care Act Special Editions to keep the ABA Health Law Section members informed on cutting-edge topics important to the health law bar. If you would like to review the past edition from June, please click here. Another series of articles will be available in August. If you have interest in contributing an eSource article, please contact Simeon Carson, Membership, Technology, and Publication Specialist, at Simeon.Carson@americanbar.org.

The False Claims Act: Analysis of the Recently Expanded Legislation on Qui Tam Actions and Related Impact on Whistleblowers
By Brian G. Santo, Esq., Pittsburgh School of Public Health, Rockville, MD / Pittsburgh, PA

The False Claims Act (FCA) was established to elicit help from private citizens to fight fraud, permitting people to sue in the name of the United States and collect a portion of the recovery the government obtains.  From 1996 through 2005, the government has recovered over $9 billion in fraudulent Medicare and Medicaid payments from qui tam actions (a private citizen, or relator, filing a complaint on behalf of the government).  However, initiating a federal health care whistleblower qui tam action proved challenging for a relator due to several factors, including the FCA’s “Public Disclosure Bar.”

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Accountable Care Organizations II: Questions & More Questions
By Mark S. Hedberg, Hunton & Williams LLP, Richmond, VA

On May 27, 2010, the CMS Office of Legislation posted on its website a series of “Preliminary Questions & Answers” (the “Q&As”) regarding the Medicare Shared Savings Program (“SSP”) established by the Patient Protection and Affordable Care Act (“PPACA”). The Q&As represent the first look into CMS’s thinking regarding accountable care organizations (“ACOs”) and how the SSP will be implemented. To set the context, the core requirement that must be satisfied by an ACO, as stated in the PPACA and the Q&As, is that the ACO must “be willing to become accountable for the quality, cost and overall care of the Medicare fee-for-service beneficiaries assigned to it.”

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Health Care Reform and Expansion of the RAC Program
By Andrew B. Wachler and Amy K. Fehn, Wachler & Associates, P.C., Royal Oak, MI 

The Patient Protection and Affordable Care Act (PPACA) calls for significant expansion of the Recovery Audit Contractor (RAC) program by the end of 2010.

The RAC program, which is currently limited to review of Medicare Parts A and B claims, uses contractors who are paid on a contingency fee basis to identify Medicare overpayments and underpayments. The program began as a demonstration program in 2005 and was expanded to a permanent program by Section 302 of the Tax Relief and Health Care Act of 2006. The permanent program was “rolled out” over several years and, as of January 2010, is now active in all 50 states.

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Grandfathered Plans: To Be or Not to Be?
By Sandra E. Quilty,  Baudino Law Group, PLC, Des Moines, IA

Last month, the Departments of Health and Human Services, Labor and Treasury issued an anxiously awaited Interim Final Rule on “grandfathered” health plans. The Interim Final Rule (“Rules”) was issued on June 14 and published in the June 17 Federal Register. The Rules provide guidance regarding what employers must do to maintain the grandfathered status of their plans as well as what would cause a plan to lose its status. The Rules are effective upon publication and comments are invited and due on or before August 16, 2010.

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Did you know membership in an interest group is FREE with your Health Law Section membership?

Did you know your membership in the ABA Health Law Section qualifies you for free membership in up to three interest groups of your choice? Interest groups, which are comprised of twelve practices areas within health law, make significant contributions to the Section's programming, publications and legislative initiatives. The interest groups also provide an excellent opportunity for you to interact with and have access to some of the most outstanding lawyers in the legal community. You can enroll on our webpage by clicking here. If you have any questions or need more information, please contact Simeon Carson at Simeon.Carson@americanbar.org.

ABA eSource Editorial Board

The ABA Health eSource Editorial Board is led by Chair Lisa Genecov, Locke Lord Bissell and Liddell LLP, Dallas, TX and editorial board members Michael E. Clark, Duane Morris LLP, Houston, TX; Adrienne Dresevic, The Health Law Partners, PC, Southfield, MI; Marla Durben Hirsch, Potomac, MD and Conrad Meyer, Chaffe McCall, LLP, New Orleans, LA.

Do you want to communicate your ideas to thousands of other members? To contribute a newsletter article on a health law topic, send us your ideas to Simeon.Carson@americanbar.org
The opinions expressed are those of the authors and shall not be construed to represent the policies or positions of the ABA or the ABA Health Law Section.
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