Payer Roundup—Health groups file suit against short-term health plan rule

Health organizations file lawsuit against short-term, limited-duration plan final rule

A group of health organizations filed suit Friday in the U.S. District Court for the District of Columbia, challenging the short-term, limited-duration insurance plan issued last month. The rule threatens consumers by undermining protections created under the Affordable Care Act, they argue.

The groups involved in the suit include the Association for Community Affiliated Plans (ACAP), National Alliance on Mental Illness (NAMI), Mental Health America, American Psychiatric Association (APA), AIDS United, National Partnership for Women & Families, and Little Lobbyists. (Release)

Senator questions Anthem response

U.S. Sen. Ben Cardin, D-Md., is raising questions about Health and Human Services' response to concerns raised about insurance giant Anthem's controversial emergency department payment policy.

Anthem rolled out a policy earlier this year to prevent "avoidable" emergency department visits to retroactively restrict coverage if the company determines the patient didn't actually have an emergency condition. The company has called it a necessary step to restrict rising health costs.

Cardin, one of the authors of the "prudent layperson" standard, is calling on HHS, as well as the Department of Labor and the Centers for Medicare and Medicaid Services to provide a progress report on the insurer's "likely" violations of the law, HealthLeaders Media reported. (HealthLeaders Media)

Doctors face prison time in 2 fraud cases

A pain-management physician from Maryland and a Detroit-area podiatrist have been sentenced to prison in two separate cases of healthcare fraud.

A judge sentenced Atif Babar Malik, M.D., 48, of Germantown, Maryland, to eight years in federal prison followed by three years of supervised release, for his role in a $1 million kickback and fraudulent billing scheme, according to the U.S. Attorney’s Office for the District of Maryland. He was also convicted of tax fraud for underreporting his income by $3.3 million. Malik was convicted on 26 counts arising from two criminal schemes.

Prosecutors said Malik and another doctor referred patients’ urine toxicology specimens to a testing company, Accu Reference, in return for the payment of kickbacks. His pain-management practice also fraudulently submitted bills to Medicare, and private insurers used a billing code that indicated two separate physicians had provided nerve block and anesthesia, when in fact, only one physician performed both.

After pleading guilty, Lawrence Young, D.P.M., 70, of Bloomfield Hills, Michigan, was sentenced to 28 months in prison for participating in a $1 million scheme involving podiatry services that were billed to Medicare but never rendered, according to the Department of Justice. Young pleaded guilty to one count of healthcare fraud in January.

Prosecutors said Young defrauded Medicare by submitting false claims for use of an Unna Boot, a type of medicated dressing applied after surgery to control swelling of the leg or foot. He submitted claims for reimbursement although patients routinely received a nonmedicated dressing. (FiercePracticeManagement)