As part of the Centers for Medicare and Medicaid Services’ (CMS) continued efforts to combat Medicare fraud, federal charges were recently brought against 90 individuals across the nation for false billings to Medicare, totaling $260 million dollars. These charges were the result of a collective task force comprising federal, state,…
Articles Posted in Affordable Care Act
Physician Servicing and Consulting Agreements and Transparency
Medical device companies, pharmaceutical companies or other health care related companies or vendors often seek consulting or personal services from doctors. Physicians should be cautious in such arrangements to avoid legal issues under federal law. Where fair market value compensation is paid for such services, there may be no issue…
The Affordable Care Act & Qui TamWhistleblower Claims
Controlling healthcare costs is essential to the economic security of the United States. Total healthcare spending in the U.S., already an astronomical $3 trillion dollars in 2013, is expected to grow almost 6% annually through 2022.1 Spiraling healthcare costs is an obvious problem on many levels, including the fact that,…
A New Prospective Payment System for Federally Qualified Health Centers
Medicare payments to community health centers are expected to increase by as much as $1.3 billion over the next five years, according to Bloomberg News, based on a new prospective payment system. On April 30, 2014, the U.S. Department of Health and Human Services’ Centers for Medicare & Medicaid Services…
Price Transparency In Healthcare: What Am I Paying For?
Shopping savvy largely derives from the discomfort of parting with money. If health insurance pays all (or most) of the bill for healthcare services, why should the patient care what the cost of the healthcare is, how such cost is calculated, or how cost might be reduced? But as a…
Possible Delay of the Affordable Care Act’s Individual Mandate
House Republicans gained the support of 27 Democrats and passed The Suspending the Individual Mandate Penalty Law Equals Simple (SIMPLE) Fairness Act (H.R. 4118), a bill that would delay for one year the Affordable Care Act (ACA) individual mandate penalty tax for those failing to buy health insurance before the…
The Affordable Care Act Will Enhance Direct Practice Medicine Opportunities
The Affordable Care Act (ACA), widely known as “Obamacare,” will create new opportunities for primary care doctors (and some specialists) who weigh starting or converting to a direct primary care model. At first blush direct care medicine practices, also known as “concierge,” “boutique” and “retainer-based” practices, which charge patients a…
WILL THE AFFORDABLE CARE ACT BE AFFORDABLE FOR EMPLOYERS?
The price Americans will pay for Affordable Care Act (ACA) changes may include lost wages and job benefits due to the price tag of ACA compliance for employers. It may seem to many like a good and noble thing to require insurers to insure everyone irrespective of health conditions and…
RISING OPPOSITION TO ACA IMPLEMENTATION
Steve Brenton, President of the Wisconsin Hospital Association, released a forceful judgment of the Obama Administration’s decision to delay by at least one year implementation of the Affordable Care Act’s (ACA) employer mandate, calling it a “dogs breakfast.” As reported in the Milwaukee Business Journal, Brenton cited five very negative…
Medicare Trust Fund Is Still Running Out of Money — Just Not as Soon As Previously Thought
On May 31, 2013, the Boards of Trustees of The Federal Insurance and Federal Supplementary Medicare Insurance Trust Funds (Boards of Trustees) issued the most recent report (the “Report”) on the financial condition of the U.S. Medicare Program. The Board of Trustees oversees the financial operations of the Medicare Part…