Health Care Lawyer Blog

The Centers for Medicare and Medicaid Services (CMS) will require nearly 1.4 million health care providers to re-validate their Medicare provider enrollment, or risk deactivation of their Medicare billing privileges.

The re-validation process is part of a massive anti-fraud effort designed to help weed out providers who fail to comply with Medicare's participation requirements. Between now and March 23, 2013, CMS will send out letters to physicians and other health care providers requesting re-validation, either through submitting a paper application or by using CMS' online enrollment system, PECOS (Provider Enrollment, Chain and Ownership System).

The re-validation process will not apply to providers who have enrolled on or after March 25, 2011, because their applications were already reviewed under heightened screening criteria.

In other words, providers should pay close attention to any correspondence received from CMS in the future. Once a provider receives a re-validation request, she will have 60 days to re-certify her enrollment information. Importantly, providers may not "preemptively" re-validate - they must wait until they receive notice from CMS before doing so.

Providers with questions about CMS re-validation should contact Mercedes Dordeski at (248) 952-0400.

The Health Care Lawyer Blog is currently under construction. Check back in a few weeks to explore our new page and, of course, continue reading about important health care law updates.

In this week's health law round-up:

- A case originally filed in a Michigan federal court challenging the constitutionality of the Patient Protection and Affordable Care Act (PPACA) is now headed to the Supreme Court of the United States. Thomas More Law Center v. Obama, et al. was among the first of a series of federal court decisions to weigh in on whether a provision of PPACA which requires all American citizens to purchase insurance by 2014 was a proper exercise of Congress' power. Judge George C. Steeh ruled in October 2010 that the law was constitutional, and the plaintiffs, a conservative public interest law firm, appealed to the Sixth Circuit. In June 2011 a Court of Appeals panel ruled 2-1 that the insurance coverage provision was a "valid exercise of legislative power by Congress under the Commerce Clause" and affirmed the district court's ruling.

Last week, Plaintiffs filed a petition for a writ of certiorari with the Supreme Court, asking the Court to rule on the issue. A response from the Obama Administration is due August 29, 2011. It is worth noting (since nearly every Republican-appointed judge has ruled against the constitutionality of PPACA) that the Supreme Court is currently comprised of five justices appointed by Republican presidents (CJ Roberts, Scalia, Kennedy, Thomas, and Alito) and four justices from Democratic presidents (Ginsburg, Breyer, Sotomayor, and Kagan). Further tipping the balance is the fact that Kagan, a former Solicitor General for the United States, may have to recuse herself from taking part in the decision of the case.

- Two Michigan lawmakers have issued a letter to the United States Department of Health and Human Services supporting the State of Michigan's request to waive the medical loss ratio (MLR) requirements for the individual health insurance market. The MLR requirement, which were included as part of PPACA, requires health insurance companies to spend a minimum amount of premium dollars on medical care and health improvement activities. This minimum amount, expressed as a percentage, is called the "medical loss ratio."

The regulation sets forth a medical loss ratio of 80 percent for insurance companies selling policies in the individual market and the small group (up to 100 employees) market, and 85 percent for insurance companies selling policies in the large group (over 100 employees) market. Accordingly, insurance companies selling policies in the individual market and the small group market must spend at least 80 percent of their premium dollars on medical care or health care quality improvement activities.

Although the Aug. 4 letter cited the predicted disaster that would occur if Michigan is not exempted from the MLR requirements, the letter was not clear on why exactly Michigan could not comply.