Strasburger Health Industry Online News

National Practitioner Databank: Due Process Requirements

Mon, 08 Mar 2010 09:00:00 CST

National Practitioner Databank: Due Process Requirements by Mary Elizondo Frazier
On January 28, 2010, the Department of Health and Human Services released a final rule governing the National Practitioner Data Bank. 75 Fed. Reg. 4656 (January 28, 2010) (to be codified at 45 C.F.R. Part 60). The final rule includes new sections requiring peer review organizations and private accreditation entities to have due process procedures in place in order to qualify as reporting agencies. These new changes became effective on March 1, 2010......

Are You Ready for an Employment Tax Audit?

Tue, 16 Feb 2010 09:00:00 GMT

Starting this month, the Internal Revenue Service (“IRS”) is commencing a National Research Project to collect information on employment tax compliance issues. But, don’t let the name fool you. The IRS plans to audit 6,000 employers over a 3-year period. Each year, 2,000 employers will be chosen for examination. The employers will be randomly selected from every geographic region of the country and business category, including tax-exempt entities. This is in addition to the IRS’s routine employment tax audits, totaling 60,000 annually.....

Enforcement Deadline for the HITECH Act Approaches - Is Your Organization Ready?

Wed, 06 Jan 2010 09:00:00 GMT

U.S. Supreme Court Clarifies Subcontractor Liability under False Claims Act by Kevin M. Wood
Enactment of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its privacy and security regulations (the “Privacy Rule” and “Security Rule,” respectively) reflected the initial attempts to move the healthcare industry into the electronic age. As noted in a prior issue of this newsletter, few changes were made to the HIPAA requirements after adoption of the Privacy Rule and Security Rule in 2001 and 2002. That all changed in February of this year with the enactment of the American Recovery and Reinvestment Act of 2009 (ARRA), and more specifically, Title XIII of the ARRA, which was named the Health Information Technology for Economic and Clinical Health Act (the HITECH Act).....

Preventing Use of Your Trademark as a User Name on Facebook

Thu, 20 Aug 2009 13:00:00 CST

by Richard D. Fladung
Facebook.com, a social networking site used by over 200 million users across the world, is no longer used exclusively by high school and college aged adolescents; it is now being used as a marketing tool by various entities, including companies, nonprofit organizations and the government...

Ouch! CMS Proposes 21.5 Percent Physician Pay Cut

Thu, 23 Jul 2009 12:00:00 CST

by Stuart F. Miller
On July 1, 2009, the Centers for Medicare and Medicaid Services (CMS) proposed changes to policies and payment rates for services to be provided in calendar year 2010 by practitioners who are paid under the Medicare Physician Fee Schedule (MPFS). The MPFS sets payment rates for thousands of physicians' services in medical offices, hospitals and other health care settings.....

Amendments to False Claims Act Pack a Punch for Health Care Providers

Thu, 09 Jul 2009 12:00:00 CST

by Earsa Jackson
On May 20, 2009, President Obama signed the Fraud Enforcement and Recovery Act of 2009 (FERA) into law. The bill, in addition to enhancing the government’s ability to prosecute financial fraud, also amended the False Claims Act (FCA), 31 U.S.C. §§ 3729-3733 (2009). Many of the changes were in direct response to existing case law that Congress concluded did not reflect the original intent of the law. Over the past 20 years, courts have gradually cut back on the scope of the FCA. However, with the increase in government funding for various programs and bailout money, Congress saw fit to reverse the effect of those decisions. According to §4 of the FERA, “[t]he effectiveness of the False Claims Act has recently been undermined by court decisions which limit the scope of the law and, in some cases, allow subcontractors paid with Government money to escape responsibility of proven frauds.”....

RAC: The Time is Now

Wed, 24 Jun 2009 09:00:00 CST

RAC: The Time is Now by Joseph A. Turano
The Recovery Audit Contractor (“RAC”) Program under the Centers for Medicare & Medicaid Services (“CMS”) has been made permanent and has officially arrived in Texas. Under this program, CMS is using private contractors (called “Recovery Audit Contractors,” or “RACs”) to review claims of providers that receive Medicare fee-for-service payments and to make determinations regarding alleged improper payments....

HIT and Health Care Reform

Tue, 02 Jun 2009 09:00:00 CST

HIT and Health Care Reform by William Duane Darling
The Engelberg Center for Health Care Reform at Brookings Institution conducted a meeting entitled "Health IT and Health Reform: Linking Incentives to Drive Accountability and Value" on May 20, 2009. The meeting was presented in cooperation with the Markle Foundation. The meeting was moderated by the Director of the Center, Mark McClellan, M.D. Dr. McClellan is the former Administrator of CMS and a Commissioner of the FDA.....

What is a Healthcare Insurance Exchange and How Does it Fit in U.S. Healthcare Reform?

Fri, 29 May 2009 09:00:00 CST

What is a Healthcare Insurance Exchange and How Does it Fit in U.S. Healthcare Reform? by Kathryn M. Darling
Kathleen Sebelius, the new Secretary of Health and Human Services, told the House Ways and Means Committee in testimony presented on May 6, 2009, that a health insurance exchange ("Exchange"), if constructed correctly, could provide the basic format for providing health care to all Americans. So what is an Exchange, how does it work, and could it really transform health care in America?.....

The HITECH Act - The Privacy and Security of Health Information Still Matters

Thu, 07 May 2009 09:00:00 GMT

The HITECH Act - The Privacy and Security of Health Information Still Matters by Kevin M. Wood
The privacy and security of health information remains a top priority for regulators. The primary federal law governing the privacy and security of health information is the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Since the issuance of HIPAA’s final privacy and security regulations (the Privacy Rule and Security Rule, respectively) in 2001 and 2002, few changes have been made to the HIPAA requirements.....

From Medicare Billing Changes to Red Flags – Compliance Requires Health Care Entities to Stay on Their Toes

Wed, 29 Apr 2009 09:00:00 GMT

From Medicare Billing Changes to Red Flags – Compliance Requires Health Care Entities to Stay on Their Toes by Michael Smith
Historically, physicians, non-physician practitioners (“NPPs”), and their organizations were permitted to bill retroactively for Medicare services provided up to 27 months prior to being enrolled in the Medicare program. CMS, however, has now implemented new provider enrollment rules in response to concerns that practitioners or organizations may submit bills, and receive payment, for services provided prior to meeting the Medicare program enrollment requirements....

You Can't Heed What You Don't Read - U.S. Supreme Court - Wyeth v. Levine

Thu, 19 Mar 2009 09:00:00 GMT

You Can't Heed What You Don't Read - U.S. Supreme Court - Wyeth v. Levine by Michael A. Walsh
This much-anticipated opinion has put to rest a hotly contested issue of whether the FDA or a jury decides if a product label sufficiently warns physicians of a product's risk. By this case, the U.S. Supreme Court has placed the decision of how much warning a product label should contain in the hands of lay juries. Levine concerned Phenergan, an injectable medication used to treat nausea. At issue was the sufficiency of a warning that an “IV-push” method of administration - where the drug is injected into the patient's vein - presented a risk that the drug will enter the patient's artery and cause irreversible gangrene...