tag:blogger.com,1999:blog-55506352024-03-17T19:59:53.348-07:00HealthLawBlogHealth care law (including regulatory and compliance issues, public health law, medical ethics, and life sciences), with digressions into constitutional law, statutory interpretation, poetry, and other things that matterTom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.comBlogger1027125tag:blogger.com,1999:blog-5550635.post-12826694187131504372024-03-14T09:02:00.000-07:002024-03-14T09:02:31.974-07:00HHS's Office of Civil Rights Launches Investigation into Cyberattack on UnitedHealth's Subsidiary, Change HealthcareOn Feb. 12, Change Healthcare experienced a ransomware attack. Most of us had not heard of Change Healthcare before then, but the effect of the cyberattack was felt widely around the country. Associated Press states that "Change Healthcare provides technology used to submit and process insurance claims — and handles about 14 billion transactions a year."As reported by Becker's CFO Report&Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-83222549163908916792024-03-12T11:56:00.000-07:002024-03-12T11:56:08.697-07:00"Automatic Enrollment in Health Insurance" (Commonwealth Fund Report)The Commonwealth Fund just published "Automatic Enrollment in Health Insurance: A Pathway to Increased Coverage for People with Low Income" (March 11, 2023) by John Holahan, Michael Simpson, and Jason Levitis. By way of introduction, the Commonwealth Fund writes: "The number of uninsured Americans — more than 26 million — remains stubbornly high, despite the availability of free or low-cost Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-8011341863627021952024-03-11T12:58:00.000-07:002024-03-11T13:00:16.559-07:00Criminal Liability of Health Care ProvidersSome types of criminal prosecutions of health care providers are rare, while others are not.1. Not-so-rare. This category includes fraud (against private insurers and public health programs like Medicare, Medicare, and Tricare); criminal prosecutions involving violations of the Anti-Kickback Law are announced by DOJ and state AGs every week (if not every day). Last Friday, for example, the Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-89111113876446881942024-03-10T14:29:00.000-07:002024-03-10T14:29:14.037-07:00Cyber Attack on United Healthcare Division Was Unprecedented in ScopeIf you've tried to fill a prescription or get preauthorization for a drug or procedure or -- if you're a health care provider -- tried to submit a bill electronically, you have experienced the widespread crippling of our healthcare infrastructure that resulted from an unprecedented cyberhack. As reported by KFF Health News (March 8), The American Hospital Association calls the suspectedTom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-12024730050327187932024-03-09T16:13:00.000-08:002024-03-10T14:40:42.461-07:00CDC Updates Guidance on COVID+ InfectionsI noted in an earlier post that the Center for Disease Control & Prevention (CDC) was considering a significant change to their recommendations for patients who test positive for Covid-19 ("Chicken Soup for COVID?", 2/18/24). Things got busy at work, and I neglected to post a link to the final version of the recommendations, which CDC pushed out on March 1. You can find the press release Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-30125823429737617592024-03-09T15:51:00.000-08:002024-03-10T13:40:45.954-07:00Revised Merger Guidelines from DOJ & FTC: What Effect on Hospital Acquisitions of Physician Practices? On Dec. 18, 2023, the U.S. Department of Justice and the Federal Trade Commission issued their updated Merger Guidelines, hitting the "Refresh" button for the first time since the publication of their 2010 Horizontal Guidelines and 2020 Vertical Guidelines. [See Wilmer Hale newsletter, 12/22/23; see also Crowell & Moring newsletter, 12/19/23 (5 key takeaways); Gibson Dunn Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-9916436050567045932024-03-08T11:07:00.000-08:002024-03-08T11:07:06.450-08:00Biden's State of the Union Address: 13 Health Care Take-awaysBecker's Hospital Review takes a look at "13 healthcare takeaways" from President Biden's State of the Union address last evening. They include:Expanding Medicare's drug price negotiation scopeLimiting drug costsExpanding rebate requirementClosing Medicaid coverage gap [for 10 states, including Texas, that haven't expanded eligibility]Capping the cost of insulinAbortion accessCOVID-19Affordable Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-16004170218483516672024-02-21T02:04:00.000-08:002024-02-21T02:04:00.130-08:00Top Four Kick-the-Can Issues in Health CareBecker's is an incredible daily resource through various newsletters aimed at hospital management, CFO's, and policy makers. From their vantage, they have a good feel for the recurring issues that government ignores and that might yield at least somewhat to public-private partnerships. Here are their top four:1. Hospital closures. It seems lawmakers only start to take notice of hospital financialTom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-20223870740952537562024-02-20T13:38:00.000-08:002024-02-20T13:38:50.050-08:00Out-of-Pocket Costs Are Top of the List of Voters' ConcernsMoney's tight. Inflation seems to be stuck at a level that bothers voters -- R, D, and Ind alike. Worries that the Fed may back off a notch or two in its current rate-reduction program seems to have spooked the equities markets, and that's an unsettling development to tens of millions of workers and retirees whose retirement plans are in managed stock portfolios. Add to all this a broadly Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-68191607321207314502024-02-18T02:15:00.000-08:002024-02-18T02:15:00.139-08:00Chicken Soup for COVID-19?Earlier this week, NBC reported that the CDC is considering a substantial change to its isolation guidelines for individuals who are COVID+. Under the proposal, individuals with COVID would be allowed to re-enter society 24 hours after they are fever-free without medications. In essence, according to the report, CDC's recommendation would be to treat COVID like the flu.Soon after the NBC story Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-18975620120688460052024-02-17T14:10:00.000-08:002024-02-17T14:10:39.221-08:00$2 Billion (with a "B") Healthcare Fraud Scheme Alleged by CMS & FBIFrom Becker's Hospital Review (Feb. 13, 2024): The FBI and CMS are investigating an alleged fraud scheme. The scheme ran for two years and involves 406,000 patients and seven firms in Connecticut, Florida, Kentucky, New York and Texas. The government is looking into the possibility that the scheme cost the Medicare program $2 billion. The scheme is described in a report by the National Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-6753319762093569602024-02-14T08:26:00.000-08:002024-02-14T08:26:05.012-08:00False Claims Act: Causation Standard Up for GrabsOn February 13 AHLA posted a nice, lengthy analysis of the circuit split over the appropriate standard for proving "causation" in False Claims Act (FCA) cases. The FCA is probably the principal vehicle for bringing claims for violations of the Anti-Kickback statute (AKB). I previously published a lengthy post of this issue on December 5 (here).Unfortunately, the AHLA analysis is behind two Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-86513979309830176552024-02-03T02:21:00.000-08:002024-02-03T02:21:00.160-08:00"Violence Against Healthcare Workers is a Silent Epidemic"From Becker's Hospital Review (Jan. 24): In 2023, Cleveland Clinic saw a record 14 million patients — and took 30,000 weapons from those patients and their visitors. Tomislav Mihaljevic, MD, president, CEO and Morton L. Mandel CEO Chair of Cleveland Clinic, delivered the statistic during the system's annual "State of the Clinic" address Jan. 24. He did not specify what sorts Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-52160747889088594992024-02-02T01:52:00.000-08:002024-02-02T01:52:00.167-08:00One Guy, $234 Million Medicare Fraud Scheme With a name that could be right out of Dickens novel, Imran Shams puts most other health care fraudster to shame. What he lacks in imagination -- his fraudulent conduct was pretty middle-of-the-road stuff -- he more than makes up with old-fashioned doggedness. The DOJ-OIG summary is illuminating:A California man was sentenced today to 10 years in prison for conspiring to conceal his Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-25689990865811943772024-02-01T10:34:00.000-08:002024-02-01T13:42:30.113-08:00Healthiest & Unhealthiest Counties in the U.S.: Texas is Tops on One of These ListsMarket Watch's latest report (January 5) ranks 576 counties based on "14 key metrics that capture the individual, environmental and structural aspects of health for a given community. This includes measures such as life expectancy and health insurance coverage, water and air quality, and food insecurity and healthcare access." Here are the high- and low-lights:Healthiest counties:1. Marin County,Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-57919207814237847632024-01-23T14:13:00.000-08:002024-01-23T14:13:39.755-08:00JAMA On-line: Scorn for Approach of Texas Supreme Court and AG in Cases Involving Exceptions to Abortion BanIn an excellent on-line (and free) commentary in JAMA (Jan. 22, 2024), three Harvard authors ask the question: "Whose Responsibility Is It to Define Exceptions in Abortion Bans?" (Disclosure: One of the authors, Louise King, M.D., J.D., is a friend and former colleague.)The context for this question is not surprising:Two Texas court cases were filed in late 2023 requesting clarification of the Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-4236843372325245912024-01-23T13:33:00.000-08:002024-01-23T13:33:53.085-08:00JAMA: Increased Depression & Anxiety in Trigger States After Dobbs DecisionIn a free article in the Journal of the American Medical Association (JAMA. 2024;331(4):294-301. doi:10.1001/jama.2023.25599) (PDF), researcher report that "[l]iving in states with trigger abortion bans compared with living in states without such bans was associated with a small but significantly greater increase in anxiety and depression symptoms after the Dobbs abortion opinion." The authors Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-35901779717876280802024-01-05T08:46:00.000-08:002024-01-23T13:35:50.767-08:00Donald Trump and the Perils of Practicing Medicine Without a LicenseHydrochloroquine for COVID? Remember when that was a thing?From The Messenger (Jan. 4):In a study published this week in the journal Biomedicine & Pharmacotherapy, French researchers found that 17,000 people died across six countries because they depended on [the] drug. Researchers say this is because the drug was used in lieu of more effective treatments, and the potential cardiovascular Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-65115234667869923272024-01-04T13:50:00.000-08:002024-01-04T13:50:44.228-08:00How Much Does the Fifth Circuit Care About Public Health?The 5th Circuit Court of Appeals has handed down a couple of decisions this week that surprised me a lot (except that this 5th Circuit is the most conservative federal appellate court in the country):1. Abortion. The Texas Tribune has a good story on the history of this litigation and Tuesday's ruling (State of Texas et al. v. Becerra, No. 23-10246 (Jan. 2, 2024). The court upheldTom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-27048839854256432362024-01-03T22:30:00.000-08:002024-01-03T22:30:00.137-08:00Four New Advisory Opinions from HHS-OIGOn Jan. 3, HHS's Office of Inspector-General (OIG) released four new Advisory Opinions, all apparently finalized at the end of December:Advisory Opinion 23-12: This favorable opinion regards a one-time, voluntary redemption offer to physician partners reaching age 67 to have their partnership units repurchased by a partnership over a 2-year period, contingent upon the physician partners’ Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-52204354037621289222024-01-03T02:40:00.000-08:002024-01-03T02:40:00.153-08:00Physician Acquitted in $15M Healthcare Fraud ProsecutionA federal jury in Maryland convicted the physician on five counts of healthcare fraud in connection with his billing practices for level 4 CPT codes for evaluation and management services (E/M) for Covid patients. According to Becker's Hospital Review:Ron Elfenbein, MD, 49, owned First Call Medical Center and Chesapeake ERgent Care, which operated multiple drive-thru COVID-19 testing sites. He Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-66905231756148735862024-01-02T14:28:00.000-08:002024-01-02T14:28:41.859-08:00UPDATED: Considerations on the Use of Neonatal and Pediatric Resuscitation Guidelines for Hospitalized Neonates and InfantsIt's always a big deal when the American Academy of Pediatrics and the American Heart Association publish an update on the use of resuscitation guidelines for neonates and infants. The latest dropped Dec. 18 (Volume 153, Issue 1. January 2024). The guidelines are different for the two groups, and deciding which guidelines to follow appears to be as much art as science. From the Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-83942992954073343152023-12-17T00:48:00.000-08:002023-12-17T00:48:00.135-08:00Medicare Cognitive Assessments: Yet Another Example of Mental Health's Second-Class StatusA new GAO report -- "Medicare Cognitive Assessments: Utilization Tripled between 2018 and 2022, but Challenges Remain" (Dec. 11) -- is a good-news/bad-news sort of thing. First, the (somewhat) good news: “Cognitive assessment and care plan services” is a service available to Medicare beneficiaries in which providers diagnose and develop a plan to manage cognitive impairments, such as Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-21715883399615370162023-12-16T02:00:00.000-08:002023-12-16T02:00:00.141-08:00Ruth Marcus: Calling Out the Texas Supreme Court for its Opinion in the Kate Cox CaseRuth Marcus is one of the most acute observers of political cultural and political life in this country. Now add legal commentary to her toolkit (she's a 1984 graduate of Harvard Law School). There's no better example than her column in the Washington Post eviscerating the Texas Supreme Court's opinion in the Kate Cox case. There's a paywall, but there may also be a quota of Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-25136625212100950902023-12-15T14:56:00.000-08:002023-12-15T14:56:28.007-08:00Kaiser: Who Decides When a Patient Qualifies for an Abortion Ban Exception? Doctors vs. the Courts Here's a thoughtful brief from the Kaiser Family Foundation on abortion-ban exceptions around the country.It starts with a quick summary of the Texas Supreme Court's opinion in the Kate Cox case and follows with some observations that somehow escaped the attention of Texas's high court:"The case in Texas highlights the impossible situation that many doctors and patients find themselvesTom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0