HHS reviewing reforms to the Anti-Kickback Statute in addition to Stark Law
The Department of Health and Human Services (HHS) is considering changes to the Anti-Kickback Statute with plans to release a request for information (RFI), Deputy Secretary Eric Hargan told lawmakers on Tuesday.
Last month, the Centers for Medicare & Medicaid Services (CMS) issued a request for information seeking public input on how to reduce the burden of the Stark Law, which has created obstacles to value-based care.
That effort was part of a “regulatory sprint to coordinated care,” with CMS, the Office of Inspector General, the Office for Civil Rights and the Substance Abuse and Mental Health Services Administration. During a hearing before the House Ways and Means Subcommittee on Health, Hargan said the group plans to release another RFI on reforms to the Anti-Kickback Statute. (FierceHealthcare)
Emergency physicians sue Anthem over ER policy change
The American College of Emergency Physicians (ACEP) is asking a federal court to prevent Anthem from implementing a new policy that restricts coverage for emergency room visits.
Since the policy was announced last year, Anthem’s Blue Cross Blue Shield of Georgia has been retrospectively denying payments for emergency department encounters it deems “non-emergent,” according to a complaint (PDF) filed by ACEP and the Medical Association of Georgia (MAG) in a U.S. District Court in Atlanta.
“As a result, providers and patients alike are operating in fear of denial of payment by Defendants when patients seek emergency department care,” the lawsuit states. (FierceHealthcare)
Patient, provider groups urge CMS to reinstate risk adjustment payments
Some of the nation's largest hospital and provider groups are speaking out against the Trump administration's decision to freeze risk adjustment payments.
A total of 28 medical organizations, including the American Medical Association (AMA), the American Hospital Association and the American Academy of Family Physicians, urged the Centers for Medicare & Medicaid Services to reconsider its decision to suspend risk adjustment payments in a letter (PDF) sent to Administrator Seema Verma on Monday.
“We are very concerned that this move will create further uncertainty in the marketplace, negatively impacting patients’ access to affordable and comprehensive coverage, and lead to higher premium increases next year,” the letter reads. “CMS’ decision to delay these [payments] jeopardizes patients’ ability to access affordable coverage as well as lifesaving care and treatment.”
Five physician organizations signed the letter, including the AMA. Last week, six physician organizations released a statement denouncing this decision as well; two of those groups also signed this week’s letter. (FierceHealthcare)
Lawsuit filed against Ohio State over sexual misconduct of team doctor
Four former wrestlers have filed a lawsuit against Ohio State University, saying school officials ignored repeated complaints of sexual misconduct by a team doctor.
The wrestlers say they were abused by Richard Strauss, M.D., whose behavior is the subject of an independent investigation by the university that began months ago. Ohio State says allegations raised in recent months about Strauss involve male athletes from 14 sports, as well as the physician’s work at the student health center and his off-campus medical office, according to the Associated Press. Strauss retired as a professor in 1998 and later moved to California, where he committed suicide in 2005.
In a separate case, the Ohio State University Diving Club also faces a lawsuit filed by two former divers who say a coach, who was fired in 2014 from the university, sexually abused them. (Indianapolis Star article)
Some doctors sue patients who post inaccurate reviews online
Doctors and hospitals are suing patients who post negative comments online, according to a USA Today review.
But several recent cases highlighted in the newspaper report show the challenges doctors face when bringing legal action against patients who post negative comments on social media or online review sites.
Last week, one lawsuit was settled in a plea deal that resulted in the patient agreeing to pay $100 for emailing his former Cleveland Clinic surgeon articles the urologist found threatening and for posting negative comments. (USA Today article)