This blog is prepared and presented by Maryland attorney Charles Jerome Ware only for information purposes, and not as legal advice. This blog does not create an attorney-client relationship.
Healthcare and hospital legal issues are ever prevalent these days in America. A few of them are as follows:
- Lawsuits against the healthcare reform act (aka "Obama-care") continue despite the new law's apparent success for the public. Despite approval by the United States Supreme Court, constitutional arguments continue to be made by those who seek failure of the law.
[AHLA Connections, Thomas More Law Center vs. Obama, Michigan District Court] - Breaches of electronic data on patients have continued to be a problem, in violation of HIPAA (the Health Insurance Portability (the Health Insurance Portability and Accountability Act of 1996).
- Federal antitrust laws are having to be reinterpreted in order to conform with the new accountable care of organizations ("ACO"s).
- False Claims and Whistleblower Lawsuits are becoming increasingly popular. The False Claims Act is a federal law that covers fraud involving any federally-funded contract or program, including Medicare or Medicaid, allowing healthcare providers to be prosecuted for various actions leading to the submission of a fraudulent claim.
- The Patient Protection and Affordable Care expands the federal government's reach under the False Claim Act ("FCA") with requirements designed to enhance fraud-fighting and to increase penalties for submitting false claims. Physicians now (since 2012) must return known overpayments to the government with 60 days of discovering an error.
- Anti-Kickback and Physician-Hospital Issues are still a priority. The Anti-Kickback statute governs a hospital's financial relationships with physicians.
- Impact of the Stark Law on Physician-Hospital Relationships increases. The Stark Law was enacted to prevent referral sources --- namely physicians and physician extenders --- from inappropriately profiting from referrals.
- Recovery Audit Contractors are increasing for hospitals, and particularly spreading in the area of Medicare payments and both Medicare & Medicaid Advantage payments.
- Compliance Requirements for Tax-Exempt Hospitals are becoming more stringent. The Patient Protection and Affordable Care Act ("PPACA") contains specific requirements for hospitals that desire to receive or maintain tax-exempt status under section 501(c)(3) of the Internal Revenue Code, changing the "community benefit standard" upon which tax-exempt hospitals have been judged for over 40 years.
And see:
(a) Community health needs assessments;
(b) Written financial assistance and emergency care policies;
(c) Limitation on charges; and
(d) Limitations on collection policies. - Co-Management Arrangements, under which a hospital pays physicians to fulfill defined duties and meet performance objectives, are a way for hospitals to create alignment with physicians.
- Changes in Reimbursement. Reimbursement rates have shifted under PPACA, significantly lowering reimbursements for some providers while increasing rates for others.
- Labor and Employment Issues. Hospitals are seeing more age discrimination claims related to termination, as well as more requests for accommodations from employees with disabilities.
- Mergers and Antitrust Law. Hospital mergers are increasing at a rapid pace, and so are concerns that some of these mergers and acquisitions violate antitrust laws. In addition to the Sherman Act, the Federal Trade Commission and the Antitrust Division of the U.S. Department of Justice enforce the Clayton Act which forbids mergers that harm competition.
- Medical Malpractice and Tort Reform continue to be major issues under constant discussion in the health field.
No comments:
Post a Comment