The patient-centered medical home (“PCMH”) concept, in which a primary care physician and an interdisciplinary team coordinate the provision of patient services, continues to gain support. In April, New York State Health Commissioner Nirav Shah, M.D. promoted the state’s new initiative to increase access to PCMHs during his National Public…
On May 31, 2011, the Department of Health and Human Services (“HHS”) issued a notice of proposed rulemaking (“Proposed Rule”) in relation to the Health Insurance Portability and Accountability Act (“HIPAA”) Privacy Rule (“Privacy Rule”). The Proposed Rule concerns changes to the accounting disclosures requirement of the Privacy Rule. The…
On Friday, June 3, the American Medical Association (AMA) submitted its comments to Donald Berwick of the Centers for Medicare and Medicaid Services (CMS) regarding CMS’ proposed rule for Accountable Care Organizations (ACOs). In its opening remarks, the AMA states the following: The AMA is pleased to provide our views…
CMS has proposed a new rule that would grant organizations that meet certain qualifications access to patient-protected Medicare data, in order to produce public reports on physicians, hospitals and other healthcare providers. These reports would be a combination of Medicare claims data and private-sector claims, identifying which physicians and hospitals…
The Centers for Medicare & Medicaid Services (“CMS”) is taking steps in anticipation of its Medicare Part D RAC program release; this component of the RAC program is expected to begin in the third quarter of 2011. The director of the Medicare Program Integrity Group, John Spiegel, announced that CMS…
On May 24, 2011, the Joint Commission announced that the new Primary Care Medical Home (“PCMH”) option for commission accredited ambulatory care organizations, by which a primary care clinician and an interdisciplinary team render patient services, will launch in July 2011. Applications from entities that are prepared for survey are…
On May 26, the American Medical Association (AMA) submitted a letter to Donald Clark–the Federal Trade Commission (FTC) Secretary–in response to the proposed FTC and Department of Justice (DOJ) Statement of Antitrust Enforcement Policy regarding accountable care organizations (ACOs). The AMA opened its letter by urging the FTC to consider…
On June 1, the Office of Inspector General (“OIG”), Department of Health & Human Services (“HHS”) announced expected recoveries of $3.4 billion from its legal actions (including investigations and other reviews, totaling about $3.2 billion) and audits (approximately $222 million). Most of the OIG reviews concerned Medicare and Medicaid. The…
Late last month the United States Justice Department announced that Areté Sleep LLC, Areté Sleep Therapy LLC and Areté Holdings LLC (“Areté”) agreed to settle false claims allegations for $650,000. The prosecution contends that from November 2002 to December 2009 Areté’s medical equipment and sleep medicine facilities in Arizona and…
In Zia Hospice v. Sebelius, CV 09-0055 CG/LFG and CV 09-1108 CG/ACT, the New Mexico District Court followed the trend set by numerous other courts, including the 5th and 9th Circuit Courts, in relation to the hospice cap regulation, 42 C.F.R. §418.309(b)(1). The Court held 42 C.F.R. §418.309(b)(1) invalid because…