- within Litigation and Mediation & Arbitration topic(s)
This is the third in a series of Barnes & Thornburg
LLP alerts on the subject of health care reform
The Healthcare Department of Barnes & Thornburg
has prepared the attached summary of significant provisions of
the Patient Protection and Affordable Care Act (Act). This summary
is intended to assist health care providers in interpreting the
many changes to the law that affect Medicare and Medicaid
providers. The Act imposes a number of new affirmative requirements
on providers related to payment, referrals, and physician
ownership. It also includes significant changes to the
government's primary enforcement tools to pursue fraud, abuse,
and overpayments.
The attached chart describes the major fraud and abuse and
"transparency" provisions of the Act and provides detail
on the following topic areas:
- Requirement for physicians referring patients to their own groups for radiology services to provide a written list of alternative radiology providers at the time of referral.
- Limitation on growth of existing physician-owned hospitals and prohibition on new physician owned hospitals after December 31, 2010.
- Revisions to the intent requirement of the Anti-kickback law.
- New requirement that overpayments must be reported and returned within 60 days.
- Changes to the time period for submission of claims.
- Establishment of a new self-disclosure protocol for "Stark" self-referral law violations.
- Reporting requirements for drug, device, and medical supply manufacturers as well as group purchasing organizations (GPOs) to identify payments to physicians and teaching hospitals.
- Reporting of drug sample distribution by manufactures.
- Additional transparency requirements for nursing homes and pharmacy benefit managers (PBMs).
- Amended intent requirement under the Anti-kickback law.
- Strengthening of fraud enforcement tools through changes to the False Claims Act, Civil Money Penalty law, sentencing guidelines, exclusion authority, subpoena power.
- Dedication of more than $250 million for fraud and abuse enforcement.
- Affirmative obligation for certain health care providers to maintain a formal compliance plan.
- Increased reporting required in connection with Medicare provider/supplier enrollment.
The Department of Health and Human Services is required to promulgate regulations that will interpret and expand on many of these new provisions. The Barnes & Thornburg Healthcare Department will continue this series of alerts with in-depth explorations of each of these provisions. A detailed summary of the fraud and abuse provisions of the Act relevant to health care providers can be downloaded by clicking on the link at the top of this page. You can also download a PDF of the summary by visiting the following url: http://tinyurl.com/266bmcd.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
