July 15, 2018 Legislation





CMS has suspended the risk corridor payments and blamed it on a court order from several months ago.  These funds were supposed to go to insurers with sicker patients to help make up for losses due to severity of illness.  This may make the premiums for next year even more expensive.  The feds really do not spend much on this program since the money actually comes from insurers with healthier patients.  The smaller newer companies will get hit where the older stable companies will actually save money.

CMS has also decided not to pay for the CAR-T drug Kymriah depending on how well it works.  Basically this kills the pay for performance idea at this time.

CMS is proposing changes to change the way physicians work.  They would only need to document clinical information in the EMR not billing stuff.  This would save clinicians many hours a year in mindless document entering.  It would change the EM System to be less rigid in the documentation needed.  It would allow more tele-medicine with paying for evaluations of patient submitted photos and brief check-ups.  It would also lower the price of some drugs on Part B Medicare.  Other changes to the MACRA and the MAGI programs are also proposed.

The SEC has issued a proposal that would limit whistleblower payouts to a floor of $30 million for awards up to $100 million and they would also have the ability to reduce an award they believe is too large.  This is after they paid out a record $83 million to three whistleblowers in a Merrill Lynch case that resulted in a $415 million settlement.

Kentucky's Governor was upset after the federal court denied the state their ability to make looking for work a prerequisite for Medicaid.  He cut vision and dental benefits to the recipients.  He states he did not do it but the judge did as those benefits were paid for under the work rule.  No money no benefit.

The law of unintended consequences is about to hit the healthcare industry in California.  The state passed a privacy law that gives consumer more control over information.  In 2020 when it goes into effect those businesses that collect information  (think Fitbit, Apple) will need to conform to the law.  It does not apply to PMI but it does apply to other information on those who do business in California.  It requires all to report to customers upon request what personal data they have collected, why it was collected and who they have sent the data to.    This is similar to the European law already on the books.  It also give a private right of action to those wronged as well as state penalties.  These potential liabilities are insurable.

California has given permission to 27 organizations to distribute and administer naloxone without a prescription.  There is a standing order signed by the Department of health Services director to allow this.  To get the authorization the organization had to apply and receive training on how to recognize an opiod overdose and administer the medicine.  It is a nasal spray sold under the name of Narcan.  

New Hampshire has a new law that requires health insurers cover birth control, but only for women and only BC pills.  The law requires at no additional cost to the patient a 12 month supply of pills if prescribed by a physician.  It does not include other forms of birth control but will still raise premiums for the people of the state.  This is why health insurance costs so much-mandates.


Lubbock County Hospital District DBA University Medical Center has paid to employees $119,175 that they illegally withheld from their wages.  The US Dept. of Labor found that they automatically deducted 30 minutes for lunch whether they took it or not.  

LA Silver Lake Medical Center agreed to pay a $550,000 fine for patient dumping.  They allegedly dumped hundreds of patients at bus and train stations instead of shelters.  They are a psychiatric hospital.

CMS has stripped Western State Hospital in Seattle, a psychiatric hospital, of its certification and federal funding.  They are the snake pit of the psychiatric world.  This was a long time coming for the hospital who said they would change but never did.  In the last three years they have lost 15 psychiatrists with no new hires and the nurses hired are educators with no patient contact.


A California physician Dr. Robert Sears has been placed on probation by the Medical Board of California.  He must take an ethics course and also 40 hours per year of educational courses.  He also must be monitored.  His crime was to tell patients not to be vaccinated and to exempt a 2 year old from the mandatory vaccination program without sufficient information.

Dr. Windell Boutte, the dermatologist who has the multiple law suits and who posted a video of herself dancing while performing surgery has agreed to a two and one half year suspension of her license by the Georgia Medical Board.  She can not call herself doctor during the suspension.


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.