tag:blogger.com,1999:blog-55506352024-03-28T10:29:54.561-07:00HealthLawBlogHealth 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.comBlogger1032125tag:blogger.com,1999:blog-5550635.post-6585904591447158272024-03-26T10:27:00.000-07:002024-03-26T10:27:22.780-07:00Happy Birthday, ObamacareMarch 23 marked the 14th anniversary of the enactment of the Patient Protection and Affordable Care Act (PPACA, a/k/a "ACA" and "Obamacare"). and the 10th anniversary of its full implementation (minus occasional trimming by the Congress and the Supreme Court). As Paul Krugman observed today in his subscribers-only newsletter, the program has been a considerable success, defying the predictions Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-66831415722692275672024-03-22T10:54:00.000-07:002024-03-22T10:54:38.263-07:00Texas Medical Board Publishes Proposed Rules Re: Exceptions to Texas's Abortion BanIt took a strongly worded "suggestion" from the Texas Supreme Court (in its "know-nothing" opinion in the Kate Cox case [HealthLawBlog 12/12/23], but the TMB has finally published a proposed rule that provides some detail about the medical exceptions to the state's ban on abortions.Notice and Statement of TMB ChairProposed Rule AmendmentOfficial Form for Submission of Public Comments (Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-8067511277028847002024-03-21T12:33:00.000-07:002024-03-21T12:33:26.807-07:00$100 Million Medicare Fraud => 9-Year SentenceDefendant Andrew Chmiel got a one-way ticket to federal prison for 9 years following his conviction for Medicare fraud, courtesy of the U.S. Attorney's office in the District of South Carolina. He was also ordered to pay $98,935,533.00 in restitution.Touting this as one of the biggest Medicare fraud cases ever, the press release on this case described the essentials of the scheme (emphasis Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-29046133319990975192024-03-20T22:30:00.000-07:002024-03-20T22:30:00.134-07:00Chevron Deference: Its Diminished Role (and Imminent Demise?)The Chevron doctrine says that federal courts will defer to agency interpretations of federal statutes as long as the statute in question is either silent or ambiguous on the subject in question and as long as the agency interpretation is "reasonable." Note first the weasel words in my description of the Chevron doctrine:ambiguous: When is a statute ambiguous? Language is Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag:blogger.com,1999:blog-5550635.post-46000643365440411222024-03-20T12:12:00.000-07:002024-03-20T12:12:24.067-07:00Prior Authorization & Your Health InsurerOnce upon a time, the way health insurance worked was this: Patients with insurance were seen by their doctors, received prescriptions for medications, and got the surgeries and other procedures their doctors believed were justified. Under these "indemnity plans," after the fact, invoices were submitted to health insurance companies, and -- by and large -- the invoices were paid. Not necessarily Tom Mayohttp://www.blogger.com/profile/09554111799163466637noreply@blogger.com0tag: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.com0