Thursday, February 28, 2013

Senate Finance Committee Takes
In-Depth Look at Fraud & Abuse


Earlier this week, I discussed the HHS and DOJ Annual Report for the Health Care Fraud and Abuse Program.  HHS and DOJ are not the only ones determined to purge the health care industry of its woes.   On January 31, 2013, a group of six current and former members of the Senate Finance Committee released a comprehensive report detailing recommendations on combating waste, fraud and abuse in the Medicare and Medicaid Programs.

The Committee, which has jurisdiction over Medicare and Medicaid, is led by current Chairman Max Baucus (D-MT) and Ranking Member Orrin Hatch (R-UT). They were joined by Senators Tom Coburn (R-OK), Ron Wyden (D-OR), Chuck Grassley (R-IA) and Tom Carper (D-DE). Together this group solicited recommendations from 164 health care industry experts across the country. According to Baucus, the Committee received over 2,000 pages of input and ideas from the nation’s health care community, which offered common sense solutions to strengthen Medicare and Medicaid.

Wednesday, February 27, 2013

Annual Report Details Record Breaking Success
in Health Care Fraud Prevention


The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) required the establishment of a national Health Care Fraud and Abuse Control Program (“HCFAC”). The HCFAC Program is a joint Department of Justice (“DOJ”) and Health and Human Services (“HHS”) coordination of federal, state and local law enforcement activities to combat fraud committed against all health plans, both public and private.

Under HIPAA, DOJ and HHS are required to release an annual report which details the amounts deposited and appropriated to the Medicare Trust Fund, among other findings.

Final Sunshine Rule:
Get Ready to Start Tracking Data


On February 8, 2013, after a long delay, the Centers for Medicare & Medicaid Services ("CMS") published in the Federal Register [1] the final rule ("Final Rule") implementing the Physician Payment Sunshine Act ("Sunshine Act") enacted pursuant to section 6002 of the Affordable Care Act. The Final Rule, while largely in line with the proposed rule, [2] makes some helpful clarifications and simplifies the requirements for reporting research payments.

In accordance with the Sunshine Act, the Final Rule has two primary reporting obligations. First, the Final Rule requires applicable manufacturers of drugs, devices, biologicals, or medical supplies covered by Medicare, Medicaid or the Children’s Health Insurance Program ("CHIP") to report annually direct or indirect payments or transfers of value made to non-employee physicians (broadly defined) and teaching hospitals. Second, the Final Rule requires applicable manufacturers and group purchasing organizations ("GPOs") to report annually any ownership and investment interests held by physicians (or any of their immediate family members) in the preceding calendar year as well as information on any direct or indirect payments or other transfers of value to such physician owners or investors (or any of their immediate family members). [3] For applicable manufacturers, there is obviously some overlap between the first and second reporting obligations, but CMS clarifies that applicable manufacturers should include payments or other transfers of value to physician owners or investors in the same report used to satisfy the first obligation.