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“Doc Fix” Signed into Law; 21% Physician Pay Cut Avoided

Posted in Legislation, Medicare

President Obama has signed the “doc fix” into law, which permanently avoids a 21% pay cut for physicians that was slated to take effect this April. The law received broad bipartisan support, passing in the House of Representatives by a sweeping vote of 392-37 and passing in the Senate by a vote of 92-8.   Continue Reading

Health Care Payment Learning and Action Network Is Open for Registration

Posted in Guest Contributor, Medicare
Anthony Knapp

Anthony Knapp

On March 25, 2015, the Centers of Medicare and Medicaid Services (“CMS”), launched the Health Care Payment Learning and Action Network (the “Network”), an ambitious  private-public partnership designed to further move the health care system away from quantity-based care and closer to value-based, quality-driven care.

The Network is being established to “help the U.S. health care payment system meet or exceed recently established Medicare goals for value-based payments and alternative payment methods.” The Medicare goals are as follows: (i) move 30% of Medicare payments into alternative payment models, such as Accountable Care Organizations, bundled payments and advanced primary care medical homes, by 2016; and (ii) move 50% of Medicare payments into alternative payment models by 2018.

Overall, HHS seeks to have almost 90% of Medicare payments tied to quality or value in the next three years.

Continue Reading

One Step Forward, One Step Out the Door – Senate Action Needed for SGR Repeal

Posted in Legislation, Medicare

The House of Representative recently passed legislation, by a sweeping vote of 392-37, which aims to change the way physicians are paid. The legislation, called the Medicare Access and CHIP Reauthorization Act, repeals and replaces Medicare’s sustainable growth rate formula (“SGR”). Despite the broad bipartisan support the legislation received in the House, the Senate failed to act on it before leaving for a two-week recess. A decision is expected from the Senate shortly after they return to the office on April 13. Continue Reading

CMS Launches Next Generation ACO

Posted in Accountable Care Organizations, Affordable Care Act (ACA)
Anthony Knapp

Anthony Knapp

The Centers for Medicare and Medicaid Services (“CMS”) has released information about a new accountable care organization (“ACO”) model, called the Next Generation ACO. According to CMS, “the Next Generation ACO Model offers a new opportunity in accountable care – one that sets more predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attract the highest quality of care.”

The ACO model has been developed as a result of the Patient Protection and Affordable Care Act. The main objective of an ACO model is to effectively coordinate high-quality care between providers and suppliers at lower costs to Medicare beneficiaries. If the ACO provides high-quality care and lowers the cost of care, it will be able to receive a share of those savings. Continue Reading

Premera Blue Cross Targeted by Hackers – 11 Million Individuals Compromised

Posted in Cybersecurity, HIPAA, Privacy, Security

Premera Blue Cross (“Premera”) announced this week that it has been the target of a sophisticated cybersecurity attack in which the information of approximately 11 million individuals has been compromised. This announcement comes on the heels of the cybersecurity attack against health insurer Anthem, Inc., which affected approximately 80 million individuals. Continue Reading

LexBlog Network References Health Law Gurus™ Blog Post

Posted in Cybersecurity, Technology

A Health Law Gurus™ blog post, “Is Your Mobile Health App HIPAA Compliant?” was referenced in a LexBlog Network article, “Apple’s ResearchKit is Living Up to the FTC’s Expectations for the Internet of Things,” written by Zosha Millman. To read a copy of the article, click here.

 

FTC May Have Authority to Regulate Companies’ Data Security Practices

Posted in Cybersecurity

Between 2008 and 2010, hackers stole credit card information from the computer network of Wyndham Hotels & Resorts LLC (“Wyndham”), which affected hundreds of thousands of Wyndham’s customers in the process. The Federal Trade Commission (the “FTC”) took action and filed suit against Wyndham in U.S District Court, alleging that Wyndham violated Section 5 of the FTC Act by failing to take reasonable measures to protect customers’ credit card information.

Wyndham has taken the position that the FTC does not have the authority to regulate the data security practices of companies. U.S. District Court Judge, Esther Salas, found otherwise. This issue is now before the Third Circuit. Continue Reading

News from the Health Law Gurus™: Week of February 22, 2015

Posted in Affordable Care Act (ACA), EHR, Fraud and Abuse, HIPAA, News from the Health Law Gurus

News from the Health Law Gurus™ is a weekly summary of notable health law news from around the country with helpful links to related content. Check back every week for the latest health law news stories.

Meaningful Use Attestation Deadline Extended to March 20, 2015 – According to a news alert from the Centers for Medicare and Medicaid Office (“CMS”), Eligible Professionals may attest to meaningful use for the Medicare Electronic Health Record (EHR) Incentive Program 2014 reporting year until 11:59 p.m. ET on March 20, 2015. The deadline has been extended to allow Eligible Professional additional time to submit their data. However, CMS encourages providers to begin the attestation process as soon as possible. CMS also noted that this extension deadline allows Eligible Professionals extra time to switch programs (i.e., from Medicare to Medicaid or Medicaid to Medicare), provided that the Eligible Professionals have not already used their one switch.  Continue Reading

OIG Report Outlines Five Recommendations for Hospice Care Reform

Posted in Affordable Care Act (ACA), Medicare

The Patient Protection and Affordable Care Act requires the Centers for Medicare and Medicaid Services (“CMS”) to reform the hospice payment system, collect data relevant to revising hospice payments and develop quality measures for hospices. In a recently released report, the U.S. Department of Health and Human Services, Office of Inspector General (“OIG”) made several findings and recommendations for CMS to consider regarding hospice reform. Continue Reading

Hospice Provider Pays $4 Million to Settle Allegations of Fraudulent Billing

Posted in False Claims Act, Fraud and Abuse

Good Shepherd Hospice, Inc., a for-profit hospice providing services in Oklahoma, Missouri, Kansas, and Texas (“Good Shepherd”), has agreed to pay $4 million to the U.S. government to settle allegations that it submitted false claims for hospice patients who were not terminally ill. Good Shepherd has also agreed to enter into a five-year corporate integrity agreement with the U.S. Department of Health and Human Services, Office of the Inspector General. Continue Reading