Hot Topics in Healthcare Law and Regulation

The health care social media legal series continues here on Healthin30, and legal expert, David Harlow, Esq, Health Care Attorney and Consultant at The Harlow Group, LLC in Boston, answers a series of questions focusing on the legal aspects of...

A proposal would forbid prescription refills. TAMPA — By the time they see Dr. Benito Torres, cancer patients just out of surgery need a strong painkiller. A pain specialist on staff at H. Lee Moffitt Cancer Center, Torres typically prescribes medication like Vicodin or Lortab, which both deliver the powerful drug hydrocodone.

What happens after the pill bottle is empty, but the pain continues? Torres can phone in refill orders to pharmacies. But that would change under a proposal to put new restrictions on painkillers containing hydrocodone.

Facing an unrelenting prescription drug abuse crisis, the U.S. Food and Drug Administration may reclassify hydrocodone into the most restricted category of legal drugs. The move would prohibit refills, meaning patients would have to return to their doctors for a new prescription.

Supporters say the move is long overdue, arguing it will force doctors to think twice before handing out a potentially addictive drug that is the most-prescribed painkilling medication in the nation.

Florida Attorney General Pam Bondi announced today that the Medicaid Fraud Control Unit has made two arrests. With the assistance of the Alachua County Sheriff’s Office, CEO Maxcine Darville and Assistant CEO Joanne Carter of the Council on Aging of Florida were arrested for using more than $2.75 million of Medicaid dollars for excessive salaries and personal expenses.

The IRS has finally released proposed Regulations relating to the requirement to maintain minimum health care insurance coverage under the terms of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act...

Declining payments and increasing financial pressures have led more physicians to become employees of large medical groups and hospitals. At the same time, the Affordable Care Act is prompting smaller practices to consolidate as a way to more easily participate in new health system delivery models such as accountable care organizations.

But as physicians attempt to escape administrative burdens and financial stress, they are encountering another hurdle­ — legal disputes brought about by mergers.

The core of the Patient Protection and Affordable Care Act is helping people get health insurance, beginning next year. That will be relatively simple for some people, but complicated for others, as this infographic produced by the Kaiser Family Foundation for the Journal of the American Medical Association shows.

Des Moines, Iowa - Once largely united in resisting the Obama administration's new health care overhaul, a growing number of Republican governors are now buying into parts of the system as the financial realities of their states' medical costs begin to counterbalance the fierce election politics of the issue.

KANSAS CITY, Mo. – Tammy Dickinson, United States Attorney for the Western District of Missouri, announced that a psychologist practicing in the Lebanon, Mo., area was sentenced in federal court today for engaging in a $1 million scheme to defraud Medicare and Medicaid.

“Those who defraud the government are stealing from the pockets of law-abiding taxpayers,” Dickinson said. “This psychologist flagrantly abused the system to enrich himself for more than three years, but today he is being held accountable for his actions.”

Rhett E. McCarty, 67, of Lake Ozark, Mo., was sentenced by U.S. District Judge Howard F. Sachs to three years in federal prison without parole. The court also ordered McCarty to pay $1 million in restitution to Medicaid and Medicare.

McCarty was a licensed psychologist and private practitioner who provided psychotherapy services to recipients of both Medicare and Medicaid in their homes in the Lebanon area. On Aug. 16, 2012, McCarty pleaded guilty to health care fraud and to forgery.

Former Baton Rouge business owners Young Okoro Anyanwu and Beatrice Anyanwu were sentenced Friday to federal prison after admitting they defrauded Medicare and an insurance company of a combined total of $485,552.

The Obama administration might be having to take on more than anticipated when the new health insurance regulations included in the Affordable Care Act kick in in 2014. An outgrowth of the protracted legal battle over the law was that states delayed doing much of the work that's required, while they waited to see if the law would stand. That has resulted, the Commonwealth Fund finds, in the majority of states being unprepared to enforce the new insurance regulations, like ending pre-existing conditions.

It appears increasingly certain that providers and insurers will see a 2% Medicare cut go into effect March 1. The automatic budget cuts queued up for that date could have an even deeper impact on the government's ability to carry out the healthcare reform law.

Across-the-board cuts to most federal programs, including parts of Medicare, were supposed to begin on Jan. 2 as part of the Budget Control Act of 2011. A year-end budget deal postponed those reductions until March to give Congress time to find ways to avoid the $1.2 trillion in 10-year cuts. 

But with the budget ax less than a month away, many health policy experts now see those cuts as close to inevitable.

Medical practices have been aligning and integrating with hospitals, but the question being asked by those attending the recent MGMA-ACMPE annual meeting was this: Now that we’re aligned and integrated, how do we make it last?

“It’s hard to keep these things together long-term,” said James Lineberger, PhD. “Disintegration is a very real possibility, but it doesn’t have to be that way.” Lineberger is principal with the Solutions Group in Boise, Idaho, and moderated a standing-room-only session called “Optimizing integration — wedding, marriage and the seven-year itch” at the Oct. 21-24 meeting in San Antonio for the organization of more than 22,000 medical group practice managers.

The health care law makes preventive care more accessible and affordable to millions of Americans by making certain preventive services, including all FDA-approved contraceptive methods, available without co-payments or other cost sharing requirements. This is especially important to women, who are more likely than men to avoid needed health care, including preventive care, because of cost. This requirement is a huge step forward for women’s health. Over the next few years, as an increasing number of health plans come under the law’s reach, more and more women will have access to a wide range of preventive services without co-payments or deductibles.

Skepticism is a two-edged sword. Not enough of it, and an IT manager might find himself duped into investing in software "solutions" that go nowhere. Too much of it, and skepticism can leave an IT department behind as it waits for enough proof to show a particular platform will improve outcomes beyond a reasonable doubt.

Big data analytics is at that tipping point right now in the healthcare industry. Several vendors promise better quality of care and reduced expenditures, but evidence to support those claims is somewhat tentative. Similarly, some critics of the big data movement say healthcare providers need to squeeze all the intelligence they can from small data sets before moving on to larger projects.

In a recent post in The Health Care Blog, for instance, consultants David C. Kibbe, M.D., and Vince Kuraitis argue that instead of succumbing to the allure of big data analytics, providers should focus on using small data better. In other words, concentrate on the clinical data already available in digitized form and use only those health IT tools that are directly applicable to care management.

Big data analytics, on the other hand, attempts to parse mounds of data from many disparate sources to discover patterns that could be useful in problem solving. For example, researchers are employing the big data approach to study genetic and environmental factors in multiple sclerosis to search for personalized treatments.

Some of this research might lead to exciting payoffs down the road, but IT companies are not waiting. As Kibbe and Kuraitis point out, technology firms are touting big data analytics as a must-have for healthcare systems and physician groups that aim to become accountable care organizations or make ACO-like arrangements with payers. As these ACOs and healthcare organizations try to profit under shared-savings or financial risk contracts, these proponents claim, big data can help them crunch the data for quality improvement and cost reductions.

Some providers are already using big data in patient care. According to BusinessWeek, "many [providers] are turning to companies such as Microsoft, SAS, Dell, IBM, and Oracle for their data-mining expertise." And healthcare analytics is a growth business. Frost & Sullivan projects that half of hospitals will be using advanced analytics software by 2016, compared to 10% today.

Are healthcare providers ready for big data analytics, or should they be content with the more limited data analytics capabilities built into their EHR systems and relational databases to point the way to new policies and procedures?

When asked to weigh in on the big data/small data debate during a recent interview withInformationWeek Healthcare, David Blumenthal, former head of the Office of the National Coordinate of health IT, said, "It's not an either/or choice. Big data starts with small data. As we have more information on health and disease and the patterns of care ... that information will provide useful insights into what works, what doesn't. What the natural history of disease is. It will enable us to do studies faster and more efficiently ... But it's going to take a while to figure out how to use the data."