Federal Judge in Florida Strikes Down the Health Reform Law

On January 31, 2011, a United States District Court in Florida held that the individual mandate provision in the Patient Protection and Affordable Care Act (“Act”) is an unconstitutional exercise of Congress’ power under the Commerce Clause of the United States Constitution. The court also held that “[b]ecause the individual mandate is unconstitutional and not severable, the entire Act must be declared void.” The court reasoned that “[i]f [Congress] has the power to compel an otherwise passive individual into a commercial transaction with a third party merely by asserting—as was done in the Act—that compelling the actual transaction is itself ‘commercial and economic in nature, and substantially affects interstate commerce’ . . . it is not hyperbolizing to suggest that Congress could do almost anything it wanted.” In concluding its decision, the court emphasized that the ruling only addressed a constitutional issue and that it was not about whether the Act was good or bad legislation.

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CMS Will Acquire New Tools to Prevent Fraud

On December 16, 2010, at the regional health care fraud prevention summit in Boston, Massachusetts, HHS Secretary Sebelius and Attorney General Eric Holder announced that CMS will issue a solicitation for new analytic tools to prevent fraud in Medicare, Medicaid and CHIP. In its press release on the subject, HHS stated that the tools will “integrate many of the Agency’s pilot programs into the National Fraud Prevention Program and complement the work of the joint HHS and Department of Justice Health Care Fraud Prevention and Enforcement Action Team (HEAT).” The tools will be designed to prevent fraudulent payments before they occur, including through predictive modeling and identification of real-time trends by tracking billing patterns and other information.

To read the full press release, please go to: http://www.hhs.gov/news/press/2010pres/12/20101216a.html.

HHS Releases “Strategic Framework on Multiple Chronic Conditions”

On December 14, 2010, the U.S Department of Health and Human Services (“HHS”) released its “Strategic Framework on Multiple Chronic Conditions” (the “Framework”). HHS describes the Framework as an “innovative private-public sector collaboration to coordinate responses to a growing challenge.” It was developed by a departmental workgroup with most of HHS’ operating divisions participating. HHS has identified four goals of the Framework, including (1) improving the health of individuals with multiple chronic conditions through system changes; (2) increasing the use of self-care management; (3) providing more information and better tools to help health professionals caring for individuals with multiple chronic conditions; and (4) facilitating research on interventions and systems that will benefit those with multiple chronic conditions. Going forward, HHS will coordinate the Framework and will solicit input from agencies within HHS and stakeholders from the private sector.

To learn more about the Framework, please go to: http://www.hhs.gov/ash/initiatives/mcc/.

CMS Introduces New Center for Medicare and Medicaid Innovation

On November 16, 2010, the Centers for Medicare and Medicaid Services (CMS) announced the establishment of the Center for Medicare and Medicaid Innovation (CMMI), under the Patient Protection and Affordable Care Act (PPACA). The acting director of the Center is Richard Gilfillan, M.D., the former president and CEO of Geisinger Health Plan and executive vice president of insurance operations for Geisinger Health System. The goal of the CMMI is to improve quality of care and make coverage more affordable for Medicaid and Medicare patients. To do this, the CMMI will collaborate with key stakeholders, which include consumers, patient advocates, physicians, hospitals, federal agencies and states. The Center will focus on three main objectives:

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Alert: CMS’s Stark Law Self-Referral Disclosure Protocol Raises Tough Decisions for Healthcare Providers

On September 23, 2010, the Center for Medicare and Medicaid Services (CMS) announced a disclosure protocol pertaining to Stark Law self-referrals in accordance with Section 6409 of the Patient Protection and Affordable Care Act (PPACA). The purpose of the Medicare self-referral disclosure protocol (SRDP) is to create a mechanism that affords both health care providers and suppliers the opportunity to disclose either real or potential violations of the Stark law. In the event of a violation, a provider’s or supplier’s submission of this information to CMS may potentially result in a reduction in the amount due for the self-referral violations. For additional information regarding the SRDP, please go to the following website: http://www.cms.gov/PhysicianSelfReferral/65_Self_Referral_Disclosure_Protocol.asp