December 15, 2012 Legislation




The feds need money and they plan to get some by charging insurance companies a user fee to participate in their exchanges to fund the exchanges.  That amount is 3.5% of the premiums offered to consumers.  This is for the exchanges that the feds and no the states will run.  The amount is higher than standard Medicare overhead.  These charges will be passed on to the consumer and will be in place of being efficient.  However, there will be a new market of between 11 million and 15 million new people to purchase the insurance.  It is expected that this will cost each person $65.

The IRS has come out with the final regs on the Obamacare tax on medical devices.  The tax will be 2-3% and most over the counter products will be exempt.  However the tax will be passed on to the purchasers of the devices who will pass it on to the insurers who will pass it on to those who purchase their insurance.  The consumers (taxpayers) will pay the tax.  The House passed the repeal of the tax in mid 2012 but the Senate will not take it up. 

CMS has come out with new rules.  They have decided to punish states that do not do what the feds want in regard to Medicaid expansion.  Those states that do not do full expansion will not get full payment.  This makes sense but is in retaliation for the US Supreme Court decision that allows the states to do partial expansion.

Some far left Dems want Obamacare exchanges to be open to illegal immigrants who qualify for staying in the country by executive fiat.  The law states that all illegal immigrants are barred from the health law.

MedPAC is suggesting a 1% bump in payments for the hospitals due to an increase in quality of care.  This does not include the 2% decrease that they will have taken away in February, 2013.  It should be seen that hospitals are using observation status instead of inpatient status to the detriment of the wallets of their patients but for an increase in payments and lack of RAC audits for themselves.

TJC has put out two new requirements.   The first is that the hospital must now report all drug errors to the physician immediately and when possible to the appropriate committee.  The second states that where allowed the hospital may include other categories of medical practioners.

States that either by referendum or legislation got money for smoking cessation are using less than 5% of that money for the cause.  The rest goes into the black hole of the state coffers never to be seen again in its original form.  The money comes from either the agreement by the cigarette companies to give $246 Billion over 25 years and the tax on the cigarettes.  Only two states Alaska and North Dakota are spending at the recommended CDC rates and only five others are spending at at least half the CDC rates.  Four states spend nothing on cigarette cessation.  They are Ohio, New Hampshire, New Jersey and North Carolina.        Top


For the first time the feds have broken the $3 billion level in how much they have recuperated in the fraud arena.  They have taken in $5 Billion so far this year.  They have left many times that on the table.

The GAO states the largest fraud came from medical facilities (18%).  This was followed by DME suppliers (16%) and beneficiaries (3%).  Most criminal cases were not referred to the Justice Department from HHS-OIG but almost all cases either pled guilty or were convicted.  Slightly less than 50% of the cases that were investigated came to an action and the rest were dropped.

The CMS lambasted UC Davis calling it incapable of rendering adequate care to patients.  This began as an investigation of three neurosurgical procedures which were experimental and done without adequate consent or oversight.  The neurosurgeons injected fecal flora into terminal brain cancers in the hope that this would increase their lives.        Top


DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.