Stopping Fraud to Pay for Reform

FRAUD1

When, earlier this year, the United States racked up two $1 billion-plus settlements from drug manufacturers for alleged fraudulent drug marketing, estimates that fraud costs the nation more than $60 billion annually gained new credence. And proponents are counting on Medicare and Medicaid fraud recoveries as a major source of funding for health care reform, says Laurence Freedman, a partner in Patton Boggs’ health care practice.

Passed in May, the Fraud Enforcement and Recovery Act broadens the federal whistle-blower act to “ensure that it reaches every corner of the health care industry, or any industry that receives federal money,” Freedman says. The bill also provides substantial additional funding for enforcement to increase the number of fraud investigations and speed cases toward expected recoveries.

Despite the publicity that has accompanied the pharmaceutical marketing cases, the bulk of the dollars wasted in fraud are likely the result of smaller-scale, blatantly criminal activities, says Laura F. Laemmle-Weidenfeld, a partner at Patton Boggs. A typical example is when a medical equipment provider, existing only on paper, charges for products never delivered to beneficiaries. But these smaller operations may not attract the attention of whistleblowers or lawyers seeking a big payday.

A new multicity Medicare fraud strike task force group, also announced in May, may put a dent in such operations, she says.

Posted in Capital Thinking MagazineComments Off

Capital Thinking Podcast

House Passes Health care Reform Legislation

A historic 219-212 vote in the House of Representatives late last night sent the health care reform bill to the President’s desk for his signature. John Jonas, head of the health care policy group at Patton Boggs, discusses:

  • The mechanics of last night’s House passage
  • Challenges involved in Senate passage this week of the “sidecar” reconciliation package
  • The implementation challenges of the bill
  • Prospective next steps on more reform legislation, and
  • What last night means for the political capital of President Barack Obama and Congressional Democrats.

Posted in Capital Check-Up, PodcastsComments Off

NQF Releases Reports on HIT Use

The National Quality Forum (NQF) released two reports this morning related to the effective use of health information technology (HIT).

The report, “Driving Quality—A Health IT Assessment Framework for Measurement,” examines, defines, and organizes the data needed to measure effective health IT use to better understand how health IT tools can improve the efficiency, quality, and safety of healthcare delivery.

NQF’s report on “Driving Quality and Performance Measurement—A Foundation for Clinical Decision Support” details the Forum’s Clinical Decision Support Taxonomy, which is composed of four functional categories that classify and categorize the CDS information necessary for quality improvement: 1) triggers, 2) input data, 3) interventions, and 4) action steps. The NQF CDS Taxonomy provides a foundation for the description of an electronic infrastructure, bridging quality measurement and health IT. Specifically, the taxonomy will enable quality measure developers, clinical system implementers, and vendors to be more effective in developing, sharing, implementing, and evaluating the effectiveness of different approaches to applying CDS aligned with quality measurement.

Posted in ReformComments Off

Additional Certification Body Announced

The Office of the National Coordinator for Health Information Technology (ONC) recently announed InfoGard Laboratories, Inc. of San Luis Obispo, California as an ONC-Authorized Testing and Certification Body (ONC-ATCB).  This is the third ONC-ATCB authorized.  As noted in a previous post, the Certification Commission for Health Information Technology (CCHIT) and the Drummond Group were the initial organizations qualified to test and certify electronic health record (EHR) systems as capable of meeting the meaningful-use criteria of the federal health IT subsidy program established by economic stimulus.

ONC stated that additional certification bodies are under review.

Posted in Capital Check-UpComments Off

MACPAC Releases Report on Medicaid Managed Care

The Medicaid and CHIP Payment and Access Commission (MACPAC) released its June 2011 Report to the Congress: The Evolution of Managed Care in Medicaid. The Commission’s report provides an overview of Medicaid managed care, including information on populations enrolled, plan arrangements, payment policy, access and quality, as well as program accountability, integrity, and data.

Posted in ReformComments Off

Capital Thinking Podcast

Given recent resignations and a death, House Speaker Nancy Pelosi needs 217 votes to pass the Senate bill. The whip count in the House remains close.  Congressman Joseph Cao, the only Republican who voted in favor of the House health care reform legislation, is not expected to lend his support to passage of the Senate bill. Representative Bart Stupak and other anti-abortion Democrats, who authored the language in the House package to prohibit individuals from using federal subsidies to purchase plans in the exchange that cover elective abortions, have been vocal that they will not support the Senate package. Department of Health and Human Services Secretary Kathleen Sebelius has suggested that the White House may strike a deal with the Congressman to address his concerns in a separate bill in exchange for support on the Senate bill. Although President Obama may be ready to move health care reform forward without Republican support, he must ensure that Congressional Leaders can rally Democrats.

White House Press Secretary Robert Gibbs said that the President wants the House to pass the Senate bill before March 18.  House Energy and Commerce Committee Chairman Henry Waxman, however, suggested that Congress could finish health care reform within the next two months. House and Senate Leadership had hoped to send a reconciliation bill to the Congressional Budget Office to be scored.

Meanwhile, last week, the Senate turned to a jobs package and tax extenders legislation, both which contain short-term fixes or extensions of expiring Medicare provisions. The Senate passed and the President signed into law H.R. 4691, the “Temporary Extension Act of 2010.” The legislation includes an extension of the Medicare physician fee fix as well as an extension of the therapy caps exceptions process through March 31, 2010.

When the Senate convenes today, it will resume consideration of the tax extenders package. The legislation is expected to pass this week with the Baucus substitute amendment, which extends the physician fee fix through the end of the year. The substitute amendment also includes a number of Medicare extenders that were included in the Senate-passed “Patient Protection and Affordable Care Act.”

Representative Charlie Rangel took a temporary leave of absence as the Chairman of House Ways and Means Committee as the House Ethics Committee ruled that he broke ethics rules by accepting trips to the Caribbean. An investigation into claims of tax evasion and failure to report income from rental properties continue.  Michigan Congressman Sandy Levin will serve as Acting Chairman.

Posted in Capital Check-Up, Podcasts, ReformComments Off

Best ED Products Reviews

The Vigaplus product is by far one of the best erectile dysfunction products on the market today. This specific erectile dysfunction product has been highly rated by many customers. Erectile issues can be caused by so many different things including lack of proper nutrition, certain disorders or diseases and much more. However, with Vigaplus you can change around your private life forever. When you are taking this pill it will only take minutes after taking it before your erection will be up and ready to go. Getting this erectile dysfunction product will be one of he best decisions that you have ever made in regards to your intimate life.

This product is the ultimate help that you will need in order to help you get and maintain an erection. There are so many ways that this product can help your erection. Not only will it help your erection but it will also increase your sex drive and the energy levels that you have during sex as well. If you purchase this product to help you get and maintain an erection you can be guaranteed that your partner will enjoy you more after you take this product than they ever had before.

vigaplus

Do not let your erectile dysfunction get you down. If you are having any issues getting or maintaining an erection allow Vigaplus to help you with your erection right away. Do not wait any longer to get back to having an intimate life. You and your partner will be glad that you chose to purchase this erectile dysfunction product. Additionally, once you have tried out this amazing, top of the market product, you are never going to want to use another product to help you get and maintain an erection ever again. Give it a try today!

Posted in FeaturedComments Off

House Action on Health Care Reform Repeal

Last night, the House of Representatives voted 245-189 to pass the the “Repealing the Job-Killing Health Care Law Act” (H.R. 2).  At this time, the Senate has no plans to take up consideration of the bill, which would be unlikely to pass and would almost certainly face a Presidential veto if it were to.

The House will next take up consideration of H.Res. 9, instructing House Committees to recommend measures to replace the reform law. Specifically, the resolution directs Committees to “proposing changes to existing law” that address many of their chief concerns with the health law including: provisions that spur economic growth and create jobs; lower health premiums; preserve patients’ ability to keep their health plan; provide people with pre-existing conditions access to coverage; reform medical malpractice; increase the number of insured; protect the doctor-patient relationship; provide States with more Medicaid flexibility; expand personal responsibility; prohibit taxpayer funding of abortions; eliminate waste; and do not accelerate the insolvency of entitlement programs.

Posted in ReformComments Off

Tick Tock – Has Time Run Out for Health Reform?

During his State of the Union address, the President did not give any insight into the best path forward for moving comprehensive health care reform. Congress continues to mull over how to pass legislation, and reform advocates are holding out hope that Members can refocus and revive the debate. Meanwhile, it has become clear that creation of new jobs will be the President’s number one priority in 2010.

The New York Times reports that Democrats are considering splitting up the bill and moving smaller pieces separately but Politicoconfirms that option may not be a simple and expeditious process.

The Washington Post reports that Democrats are still contemplating on how to proceed but lawmakers remain steadfast in their commitment to passing legislation and maintain that reconciliation is still on the table.  We anticipate that Democratic leaders will continue to caucus over the next couple of weeks to work on developing a sustainable path forward.

In other health news, while the Democrats still maintain a filibuster proof majority before Republican Senator-elect Scott Brown is seated, the Senate managed to pass a resolution that increases the debt ceiling to $14.3 trillion, which greases the wheels for a potential five-year Medicare physician payment fix that would be exempt from the pay-as-you-go rules.  Congress is still required to pass legislation to stop the 21 percent cuts from going through on March 1, 2010.

Posted in Legislation, ReformComments Off

Capital Thinking Radio Show

CT_radio1 Join us this week on Capital Thinking this week as host Kevin O’Neill examines the political impact of the recent House approval of the most sweeping piece of social legislation in decades. John Jonas and Martha Kendrick provide strategic analysis of the bill and what to expect next.

Tune in every Thursday at NOON EST and 9:00 am PST on VoiceAmerica Business

Posted in Legislation, ReformComments Off