Health Care Lawyer Blog

The number of patients lacking health insurance is on the rise in the nation’s public hospitals, according to a survey released this week by the National Association of Public Hospitals and Health Systems (NAPH). The survey, which examined the patient population at so-called “safety net” hospitals (which typically deliver a significant level to low-income and vulnerable populations) reported an increase of 23 percent in the number of uninsured patients receiving care at their facilities since the start of the recession.

While examining patient populations at safety net hospitals may seem counter-intuitive, the results of the survey also show a 10 percent increase in uncompensated care costs at public hospitals. These costs can average up to $2.3 million per hospital, with some hospitals incurring additional costs of upwards to $16 millions.

Forty-one health systems participated in the survey, which was conducted during the second half of 2009. Although safety-net facilities represent just 2 percent of the hospitals in the count, they provide 19 percent of all hospital-based uncompensated care.

The NAPH’s report was released on the eve before today’s health care reform summit, which is the latest in President Barack Obama’s attempt to resuscitate his health care reform efforts. Efforts to pass legislation stalled as a result of last month’s GOP Senate victory in Massachusetts, which stripped the Democrats of their all-important 60th vote.

While efforts to pass health care reform legislation are currently at a standstill, some states are already braced to object to requirements that all Americans carry health insurance. This proposed mandate, which was included in both the House and Senate versions of reform legislation, allows the government to impose financial penalties on individuals who do not carry health insurance.

According to a recent Detroit Free Press column, legislatures in 36 states – including Michigan – have proposals pending to reject such requirements in the name of states’ rights. Those who oppose the requirement, such as the Health and Human Services Task Force at the American Legislative Exchange Council, claim the mandate it akin to “the government requiring something of you because you exist.”

“This is not like requiring care insurance for the privilege of driving,” said Jorge Amselle, director of public affairs for the council. “If you exist, you have to have health insurance.”

Generally, the Bill of Rights gives the states “the powers not delegated to the United States” in the U.S. constitution. However, the Constitution acknowledges that the government was established to “promote the general welfare.” Additionally, the Constitution also provides Congress with the power to “regulate commerce…. Among the several states.” This is commonly referred to as the “commerce clause” and is liberally construed. Specifically, under Congress’ ability to regulate any state-level activities having a “substantial effect” on interstate commerce, Congress may easily have the power to regulate insurance coverage.

After the jump - Constitutional considerations on mandatory coverage

Continue reading " States Balk At Proposed Mandatory Health Care Coverage " »

Next week marks the deadline for health care covered entities and business associates to comply with several privacy law requirements implemented by the 2009 Health Information Technology for Economic and Clinical Health Act (a.k.a. HITECH Act). Specifically, under the language of the Act, the following must be satisfied by February 18, 2010:

- Business Associate Agreements. Previously, business associates were required to comply with HIPAA-related privacy laws through a contract with a covered entity, but were not directly responsible for HIPAA compliance. Now, business associates are bound by the HIPAA laws, and must have policies and procedures documenting the same. Specifically, any business associate who performs work on behalf of a covered entity with respect to the entity’s “covered functions” must amend their business associate agreements to add language that the business associate must comply with the HIPAA rules (including breach notification requirements) and include details on how the business associate will store and safeguard PHI.
- Minimum necessary rule. Covered entities are now required to use or disclose only the “minimum necessary” amount of PHI required to complete a covered function. While HHS has yet to issue guidance on the definition of “minimum necessary” (such details are expected to be released August of 2010), effective February 18 covered entities are to use a “limited data set” or the least amount of PHI necessary to accomplish the intended purpose.
- Request for restrictions. Currently, covered entities must allow individuals to request restrictions on how their PHI may be disclosed, but are not required to honor such requests. For example, a patient who pays out-of-pocket can request that his health care provider not disclose information about his medical condition or treatment to his employer/insurer. Under the old privacy laws, a covered entity was required to accept the patient’s request but did not have to act upon it. Effective February 18, however, covered entities must honor requests not to disclose PHI (for purposes of payment or health care operations only) if the patient pays the entire cost of treatment out-of-pocket.

After the jump - HITECH amends access, marketing policies

Continue reading " Major Changes to HIPAA Laws Take Effect Feb. 18 " »

As part the of nationwide “Communities Putting Prevention to Work” initiative (or as I like to call it, the “Duh” initiative), the Department of Health and Human Services has awarded $119 million in grant monies to states and U.S. territories to support efforts to reduce obesity, increase physical activity, improve nutrition and reduce smoking. The initiative is funded through the American Recovery and Reinvestment Act and is directed at curbing “behavioral” waste, which is often cited as a factor in the rising costs of health care.

The monies will be allocated to all 50 states, the District of Columbia, and U.S. territories to help communities and schools support healthy choices. For example, one projected use of the funds will go towards using the media to support healthy food and beverage choices and increase physical activity, and increasing access to health choices and “safe” places to be active (which is a often-cited as a concern in inner-city areas). Grant monies will also be used to fund “quitting hotlines” for smokers and media campaigns promoting tobacco cessation.

The awards are broken up into three major categories – 1) Statewide policy and environmental change; 2) competitive special policy and environmental change, and 3) Tobacco cessation through quitlines and media. The awards to Michigan are as follows:

Policy and Environmental Change - $1,299,666
Competitive Special Policy and Environmental Change Initiative - $1.5 million to reduce exposure to second-hand smoke, including partnering with Native Americans.
Tobacco cessation through quitlines and media - $1,251,009

The grants to Michigan represent are among the largest in each of the three categories (Michigan received the seventh-highest for Policy and Environmental; seventh in Tobacco cessation, and was included as one of 13 states to receive funding for special policy and environmental changes.) Some examples of other states initiatives under the latter category include a grant of $2.7 million to Texas to promote breastfeeding; $2.3 million to Minnesota to revamp school lunch menus; and $3 million to North Carolina to “conduct a state-level policy analysis and develop a process to promote physical activity through land use and transportation planning.”

After the jump - Michelle Obama's Let's Move! campaign

Continue reading " HHS Awards $119M in Grant Monies to Promote Healthy Lifestyles " »

As a blogger, I do so enjoy occasions where government officials confirm my observations.

For example, last Wednesday I posted on how health care reform legislation should focus on combating fraud as a way to reduce the rapidly escalating costs of care. On Thursday, during the National Summit on Health Care Fraud held in Bethesda, Maryland, Attorney General Eric Holder disclosed that Justice Department records show that efforts to combat health care fraud have stalled in the past two years.

Holder stated that two years after the federal government ramped up its efforts to combat Medicare fraud, the number of people charged with such fraud has barely changed. Specifically, federal prosecutors have charged 803 people with defrauding medical insurers in FY 2009. (Nearly all of the charges involved Medicare fraud.) This number represents a mere 2 percent increase since the government began deploying “strike forces” to target fraud in 2007.

The 2007 strike force targeted fraud in Miami, and following the inception of the Miami program the number of people charged with health care fraud leaped nearly 35 percent. The strike force program, also known as the Health Care Fraud Prevention & Enforcement Action Team or HEAT, has since been expanded to six other cities (Detroit, Houston, Los Angeles, Baton Rouge, New York, and Tampa). Strike force efforts in the latter three cities began in December of 2009.

Notably, according to Louis Saccoccio, head of the National Health Care Anti-Fraud Association, many of the charges constitute “low hanging fruit” and while the government has generally done a good job targeting fraud, there are many undiscovered cases.

During the Summit, Attorney General Holder noted that fraud costs Medicare an estimated $60 billion a year. This is number is significantly higher than reports from the FBI, which estimates that combined fraud in all health care programs eats up 3-10 percent of total health care spending. Since the operating costs for the Medicare program in FY 2008 ran around $460.9 billion, $60 billion in losses would mean that fraud accounts for 13 percent of the Medicare budget.

After the jump - where anti-fraud efforts will be directed

Continue reading " Anti-Health Care Fraud Efforts Stalled, According to AG " »