August 2012 Archives

August 30, 2012


Adrienne Dresevic, founding partner of Southfield, Mich.-based The Health Law Partners, has been appointed chair of the American Bar Association (ABA) Publications Committee, liaison from the publications committee to The Health Lawyer Editorial Board and chair of the Stark & Anti-Kickback Toolkit Editorial Board. Founding partner, Carey Kalmowitz made the announcement.
As chair of the Publications Committee, Dresevic will work with section project managers to actively increase the number of publications produced by cultivating an encouraging atmosphere with the ABA Interest Groups and strong support from the Publications Committee.
Dresevic will serve as a facilitator and ensure open communication in her role as liaison between The Health Lawyer Editorial Board and the Publications Committee.
Serving as chair of the Stark & Anti-Kickback Toolkit Editorial Board, Dresevic will work toward increasing subscriptions by improving and updating the toolkit from prior years.
An avid writer and speaker, Dresevic has published over 60 articles on healthcare law and presents at national conferences throughout the year. Dresevic's practice encompasses the full spectrum of healthcare law and has specialized her practice in Stark and fraud abuse. She received her juris doctorate from Wayne State University Law School, finishing second in her class magna cum laude, and was a member of the Order of the Coif.

Southfield, Mich.-based The Health Law Partners is a law firm dedicated to the practice of healthcare law. The firm takes pride in delivering progressive results for their clients and exceeding their high standards for service. Established in 2009 by Adrienne Dresevic, Jessica Gustafson, Robert Iwrey, Carey Kalmowitz, and Abby Pendleton, the firm has built a national network, with additional offices in New York and Atlanta. Clients include solo practitioners, group practices, hospitals, hospice organizations and health systems.

The firm has extensive knowledge and experience in Stark and Anti-Kickback law compliance, healthcare billing and reimbursement issues, healthcare transactional work, and Medicare and Medicaid appeals, as well as licensing issues, physician and staff privileging, and participation with third-party payers. HLP attorneys are adept at providing post-audit defense and appeals, a specialty that also provides them with valuable insight and experience into the compliance side of the legal equation--identifying and addressing avoidable vulnerabilities and exposures.


August 28, 2012

Drafting Managed Care Contracts: Considerations for Providers

We are pleased to announce that Claudia Hinrichsen, Esq. will be speaking in an upcoming Strafford live phone/web seminar, "Drafting Managed Care Contracts: Considerations for Providers" scheduled for Thursday, September 6, 1:00pm-2:30pm EDT.

Healthcare reform is driving fundamental changes in the relationship between providers and managed care companies and introducing new approaches for contract negotiations. Negotiating favorable rates and terms in this new environment is more challenging than ever.

Counsel for providers negotiating managed care contracts must carefully consider several highly technical and complex provisions and anticipate potential areas of dispute. Counsel must also take steps to minimize potential exposure for the provider for nonperformance of obligations under the contract.

My fellow panelists and I will provide healthcare counsel with a roadmap for drafting and negotiating managed care contracts on behalf of providers. The panel will discuss key provisions in the agreements and strategies for resolving common areas of dispute.

We will offer our perspectives and guidance on these and other critical questions:

• How is healthcare reform impacting the negotiation of managed care agreements?

• What strategies have been effective for providers' counsel in negotiating favorable provisions in managed care contracts?

• What are the most commonly disputed issues during contract negotiations and what are some effective approaches for resolving them?

After our presentations, we will engage in a live question and answer session with participants -- so we can answer your questions about these important issues directly.

I hope you'll join us.

For more information or to register please call:
1-800-926-7926 ext. 10 (mention code: HSZBJ3-PZO1AE)

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August 24, 2012

CMS Issues Final Stage 2 Rule

On Thursday, August 23, 2012, the Final Rule regarding the Stage II Meaningful Use requirements was published. This Final Rule sets forth the requirements eligible hospitals and other eligible providers must meet in order to receive payments under the program, which provides incentive payments to Medicare and Medicaid providers that adopt qualifying EHRs. Stage II will go into effect in early 2014.

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August 17, 2012

Innovation Awards

This summer the Centers for Medicare & Medicaid Innovation announced 81 Health Care Innovation Awards made pursuant to the Affordable Care Act. Recipients were selected based upon their innovative solutions to addressing problems facing their communities and their ability to "deliver high-quality medical care, enhance the health care workforce, and save money." See The U.S. Department of Health & Human Services Page. The awards will be made over a three year period pursuant to cooperative agreements.

Each of the selected projects demonstrates the federal government's interest in enhancing quality of care and improving efficiency within the health care system through evidence based medicine, information technology and patient-centered coordinated care.

Recipeints of the Health Care Innovation Awards are located in all 50 states, the District of Columbia and Puerto Rico, including without limitation 8 projects in Michigan and 13 projects in New York.

Two recipients that exemplify the types of initiatives currently embraced by CMS (and, more specifically, the Health Care Innovation Awards) are described below.

Reducing Inappropriate Imaging in Southeast Michigan

The Altarum Institute, in partnership with United Physicians and Detroit Medical Center Physician Hospital Organization, has received an $8.4 million dollar award from CMS to reduce unnecessary medical imaging. Through this program (titled "Comprehensive community-based approach to reducing in appropriate imaging"), Altarum will "embed clinical guidelines in the image ordering process, leverage health information exchange capabilities to increase awareness of past imaging results and use patient education campaigns to offset patient-induced demand for medically unnecessary imaging." The goal is a 17 percent reduction in imaging costs (and also a reduction in associated medical risks of performing unnecessary imaging) without reducing the quality of care provided to patients. Altarum also intends to implement this project in conjunction with the American College of Radiology.

Coordinating Care of the Mentally Ill in Southwest Brooklyn

Maimonides Medical Center, in partnership with numerous other health care and community organizations, insurers and a labor union, has received a $14.8 million dollar award from CMS to improve care for adults with serious mental illness who live in southwest Brooklyn. The project would enable medical and mental health providers to communicate with each other through use of advanced health information technology. The goal is to reduce psychiatric and medical hospital admissions by 30%.


As providers and suppliers within the medical community contemplate participation in projects such as those described above, through acquisition or use of information technology or otherwise, it is highly advisable to engage legal counsel to provide compliance guidance and review participation and other agreements before proceeding. Competent and experienced attorneys are able to identify potential regulatory issues and ensure that their clients maintain flexibility (to the greatest extent practicable) in this rapidly changing health care environment.

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August 17, 2012

Drafting Managed Care Contracts: Considerations for Providers

Claudia Hinrichsen, Esq. will be presenting "Drafting Managed Care Contracts: Considerations for Providers", A live 90- minute CLE webinar/teleconference with interactive Q&A on Thursday, September 6, 2012.

Continue reading "Drafting Managed Care Contracts: Considerations for Providers" »

August 1, 2012

Public-Private Partnership New Tool in Fight Against Health Care Fraud

On July 26, 2012, Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder announced that the federal government and several leading private and state organizations have teamed up to detect and prevent payment of fraudulent health care billings. In the short term, the voluntary partnership will be a medium through which information and best practices will be shared. The longer term goal is to be able to perform sophisticated analysis that will detect and predict fraud schemes. Members are hoping that the partnership will aid in revealing and stopping scams that involve public and private payers. One short term goal of the partnership is to be able to detect when two insurers are being charged for care provided to one patient in different cities on the same day.

Secretary Sebelius said, "This partnership puts criminals on notice that we will find them and stop them before they steal health care dollars." She also credited the Affordable Care Act with providing additional necessary anti-fraud tools.

The operational structure of the partnership is still being worked out, and the first meeting between the Executive Board, the Data Analysis and Review Committee, and the Information Sharing Committee is planned for September. There are a number of organizations and agencies that have been quick to join this partnership.

The Affordable Care Act has already provided additional tools to combat fraud. The Centers for Medicare and Medicaid Services (CMS) is already using new technology to review claims before they are paid in order to track fraud and flag suspect activity. The Affordable Care Act also increases sentencing guidelines for health care fraud by 20-50% for crimes involving more than $1 million in losses and makes it easier for the government to recover lost funds. Between 2009 and 2011, convictions under the Health care Fraud and Abuse Program increased by more than 27%.

The Affordable Care Act expressly authorizes CMS to suspend payments to providers or suppliers while an investigation for fraud is ongoing. This is a big change to the prior practice of paying all claims, then trying to recoup money once fraud is detected.

Continue reading "Public-Private Partnership New Tool in Fight Against Health Care Fraud" »