SZD Health Law Scan : Health Care Lawyers & Attorneys : Schottenstein Zox & Dunn Law Firm : Strategic Planning, Managed Care, Insurance : Columbus, Cleveland, Cincinnati, Central Ohio

Schottenstein Zox & Dunn Co., LPA, the Health Policy Institute of Ohio and the Employers Health Coalition of Ohio’s Health Care Reform symposium is now at capacity. However, those who are unable to attend on Oct. 27 can follow us on Twitter at @szdlaw or #hcrsymposium to get live updates about the discussions during the conference.

The symposium will address the impact of federal and state health care policy reform efforts among key Ohio stakeholders in the health care industry. In addition to obtaining an overview of the current state of health care policy reform, attendees will benefit from the views and opinions of Ohio policymakers and leaders in the provider, payor and employer communities on health care policy reform through informative panel discussions and interactive question and answer sessions. Key questions to be addressed include:

• What is the current status and substance of the federal government's health policy reform efforts?
• What is the status and substance of any Ohio health policy reform initiatives?
• How will adopted (or proposed) reform legislation impact the provider, payor and employer communities?
• What are these stakeholders' key concerns about health care reform?
• What opportunities does health care reform present for these stakeholders?

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The American Hospital Association released a helpful Recovery Audit Contractor Program Update dated October 5, 2009. There is a password required.

The report is also available on the Ohio Hospital Asssociation website as well.

A few highlights:

• To date, CMS has approved only automated audits, which rely on software analysis to find technical errors such as coding errors.
• CMS has delayed approval of complex audits, including medical necessity reviews, in order to finalize processes and policies related to requesting and auditing medical records.
• DRG and coding validations are likely to begin in November 2009 at the earliest, with medical necessity reviews delayed until 2010.AHA has made available to all hospitals a free claim-level Excel tool to assist in tracking RAC audits.

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The Senate Finance Committee has approved its health care reform legislation, entitled "America's Healthy Future Act." This legislation will now have to be merged with the version approved by the Senate Committee on Health, Education, Labor and Pensions (the "HELP Committee").

The two bills share many common concepts, such as penalties for individuals who fail to obtain health insurance, expansion of Medicare and requirements for insurance plans that, for example, include prohibitions on exclusions for pre-existing conditions.

However, the Finance Committee's version differs from the HELP Committee's in some significant ways. First, the Finance Committee's version does not establish a government-run health insurance plan, commonly referred to as a "public option," that would compete in the health insurance exchanges with private health insurance plans. Second, it does not mandate employers to provide health insurance. Third, it proposes different methods for financing the cost of the legislation. For example, the Finance Committee's version proposes assessing fees on pharmaceutical manufacturing companies ($2.3 billion), medical device manufacturers ($4 billion), health insurance providers ($6 billion), and clinical laboratories ($750 million).

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The October 7, 2009 edition of the Federal Register will publish interim rules implementing the Genetic Information Nondiscrimination Act’s prohibition against discrimination in the administration of health insurance coverage and group health plans. The federal agencies involved (Labor; Health and Human Services; IRS) are requesting comment on the interim rules, which will take effect 60 days after their publication (December 6, 2009).

The interim rules implement GINA’s prohibition against health benefit plans and health insurance companies increasing rates based on genetic information; requesting or requiring genetic tests; and requesting, requiring or purchasing genetic information for use in connection with enrollment or underwriting. These interim rules follow upon the EEOC’s proposed rules regarding GINA’s application to employment practices, which were issued earlier this year.

In our prior article, “The Surprising Breadth of GINA’s Protections,” we noted that the definition of “genetic information” in the EEOC’s regulations includes family medical history information. This information may not itself be genetic in nature but may reveal the occurrence of a genetically-based disease in the individual’s family. That same broad definition is incorporated into the interim regulations for health insurance coverage and group health plans. 

Comments on these interim rules may be submitted through the federal eRulemaking portal. Comments are due 90 days following the publication of the interim rules, or by January 5, 2010. For questions regarding the application of these interim rules to health insurance coverage and group health plans, please contact David Ball or any member of SZD’s Health Law Practice Group.

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The White Collar Crime Prof Blog is posting information from the National Association of Criminal Defense Lawyer's Annual Defending the White Collar Case Seminar. A keynote address was given by Lanny A. Breuer, Assistant Attorney General, Criminal Division, Department of Justice. 

Breuer had the following to say about health care fraud:

"On the topic of health care fraud, which he called 'particularly severe,' Breuer said that much of the $800 billion dollars per annum that the government spends on Medicare and Medicaid is lost to 'waste, fraud and abuse,' which he estimated at a minimum of 3% of those expenditures. In this context, interagency efforts are being pursued in what he characterized as an 'innovative, data driven approach.' For example, pointing to multiple recent indictments in Detroit, Mich., he said that government investigation is driven by data such as information about which geographic areas have higher Medicare billing. He promised that such enforcement action will be spreading to new cities, explaining that government data shows that Medicare billings go down after the strike force goes into cities. "

The White Collar Crime Prof Blog is edited by Ellen S. Podgor, Professor of Law, Stetson University College of Law. The Breuer post was written by Guest Blogger Ivan J. Dominguez, Assistant Director of Public Affairs & Communications, National Association of Criminal Defense Lawyers. 

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The Office of Inspector General ("OIG"), Department of Health & Human Services, released its Work Plan for fiscal year 2010.  The Work Plan describes the work the OIG plans to initiate or continue in the coming year. 

A copy of the Plan is here oig.hhs.gov/publications/workplan.asp

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