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Why We Must Care About Medicare0

California Healthcare News published this article, Why We Must Care About Medicare, on October 11, 2016.

“It’s kind of fun to do the impossible.” – Walt Disney

A Federal Circuit Court of Appeal recently commented, “Medicare is, to say the least, a complicated program.” United States health insurance for people 65 and older has 37,000 separate guidance documents online at the Centers for Medicare & Medicaid Services (CMS), myriad federal regulations expounding upon 50 years of statutory direction, and a legion of Federal Court decisions adding even more detail. To be sure, health care providers should exercise great caution before sharing in Medicare’s $650 billion annual fund. Unfortunately for those ambivalent about Medicare with all of its complexities, not to mention anyone who outright hates the program, resistance is probably futile. … Read more →

Oct 11th, 2016 Uncategorized

Supreme Court Decision Adds More Confusion to False Claims Act0

This article, Supreme Court Decision Adds More Confusion to False Claims Act, was first published July 12, 2016 at California Healthcare News.

“The darkest places in hell are reserved for those who maintain their neutrality in times of moral crisis.” — Dante Alighieri

As modern medicine continues its attempts to bridge the gap between body and mind to provide more comprehensive care for patients, so too must the Federal Government address this gray area while endeavoring to regulate care for those less tangible medical issues of the mind. The already elaborate labyrinth known as the Medicare Act has recently grown even more chaotic under the recent Supreme Court decision Universal Health Services, Inc. v. United States (ex rel. Escobar), which further blurs the line between false and fraudulent claims.

Teenage Medicaid beneficiary Yarushka Rivera sought guidance at Arbour Counseling Services in Lawrence, Massachusetts. The facility diagnosed Rivera as bipolar, although the Arbour “Ph.D.” rendering this opinion failed to disclose that her degree was from an unaccredited Internet-based college, or that Massachusetts had rejected her application for licensure as a psychologist. Twenty-three other Arbour “clinicians” also lacked the purported mental health professional licensures Arbour professed to represent. Not surprisingly, the service’s “prescribing psychiatrist” was in fact a registered nurse who lacked the credentials to do so. Arbour also misrepresented various payment codes, such as “family” or “individual” therapy, and it was discovered to have lied in its attempt to garner National Provider Identification (NPI) numbers for its non-practitioners. Needless to say, Rivera’s mother Carmen Correa and stepfather Julio Escobar were not pleased upon learning of the facility’s transgressions from an Arbour counselor five years into Rivera’s treatment. … Read more →

Jul 12th, 2016 Administrative, Clinical, Community, Health Care Law, Historical, Miscellaneous, News, Non Clinical, Regulatory

Health Care’s Unfinished Bridge0

This article, Health Care’s Unfinished Bridge, was first published in California Healthcare News on April 5, 2016.

“We must be willing to let go of the life we planned so as to have the life that is waiting for us.” – Joseph Campbell

Every era relies on the intuition of a talented few in its search for scientific breakthroughs. Herodotus rejected the notion the Earth was flat, and in particular its description on the Shield of Achilles in Homer’s Iliad. Some 29 centuries later, science has reduced the labors of Homer to little more than myth, though philosophy still honors the epic, from its very first word (“μῆνῐν” or “wrath”) to its lesson addressing the value of balancing excessive pride with the fear of anonymity. Similarly, advances in technology have greatly benefited medicine in recent generations, as doctors increasingly approach diseases of the body from a tangible perspective. However, the treatment of diseases of the mind continues to be far more speculative in nature, serving to highlight the chasm between these two seemingly similar but ultimately disparate fields. This in turn presents a complex issue for both medical practitioner and mental health provider. … Read more →

Apr 5th, 2016 Administrative, Clinical, Community, Health Care Law, Health Care Reform, Historical, Hospitals, News, Non Clinical, Technology, Uncategorized

Health Care Is Not One Word Or One Person0

This article, Health Care Is Not One Word Or One Person, first appeared in the Los Angeles Daily Journal on February 24, 2016.

“The truth is rarely pure and never simple.” — Oscar Wilde

With the passing of Justice Antonin Scalia, the Supreme Court has lost a brilliant legal scholar and formidable protector of the U.S. Constitution. Scalia both earned respect and instilled fear during his 30-year tenure supervising America’s political climate. While his legacy ought to take precedence during this time of mourning, widespread panic over the future of health care reform threatens to overshadow the passing of Scalia the individual in favor of highlighting the ways in which his unexpected death may advance partisan agendas.

History has shown that a single justice can have a dramatic effect on the formation and defense of policy. In 1896, Justice John Marshall Harlan disagreed with those Supreme Court justices who believed that the Constitution allowed “equal but separate” public transportation accommodations for black and white citizens. His solitary dissent in Plessy v. Ferguson argued otherwise, stating that the Constitution did not create a “superior, dominant, ruling class of citizens” in the United States, and that the Constitution was itself color-blind. Fifty-eight years later, a unified Supreme Court made history with Brown v. Board of Education of Topeka in holding that “separate but equal” had no place in public education. … Read more →

Feb 24th, 2016 Administrative, Clinical, Community, Health Care Law, Historical, Hospitals, News, Non Clinical, Regulatory

Health Care’s Adventures in Wonderland0

This article by Craig B. Garner[1] and Jessica Weizenbluth[2], Health Care’s Adventures in Wonderland: Provider Agreements for Electronic Records, was first published in February 2016 in California Health Law News.

“Now, here, you see, it takes all the running you can do, to keep in the same place. If you want to get somewhere else, you must run at least twice as fast as that!”[3]

I. INTRODUCTION

Y93.J1: Activity, piano playing[4]

Today’s health care provides its own spin on the word “complex,”[5] while at the same time forging possible paths to what may be “unwinnable” scenarios.[6] For the modern physician[7], the universe within which he or she exists requires updated definitions for words such as “complex” and “challenging,” especially as that “perfect storm”[8] also known as health care reform continues to age. Somewhere in between the 2015 Physician Quality Reporting System (“PQRS”)[9], the Physician Value Based Payment Modifying Policies (“VBP”)[10] and tenth revision of the International Statistical Classification of Diseases and Related Health Problems (also known as ICD-10),[11] physicians find themselves still struggling to adopt electronic health records (“EHR”) in practice.[12]

As technology continues to evolve, there remains a general landscape with which those in the health care field must familiarize themselves. Even from this challenging vantage point, providers still have opportunities to bolster their position and practice their craft as they continue down the digital path and adopt an EHR system for which the Federal Government established incentive payments.[13] … Read more →

Feb 17th, 2016 Administrative, Clinical, Community, Health Care Law, Health Care Reform, Hospitals, Miscellaneous, News, Non Clinical, Regulatory, Technology

Killing HIPAA0

This article, Killing HIPAA, first appeared in California Healthcare News on February 8, 2016.

“When truth is buried, it grows. It chokes. It gathers such an explosive force that on the day it bursts out, it blows up everything with it.” -Emile Zola

The issue of confidentiality when applied to modern American healthcare is fraught with differing objectives, creating myriad complications as the needs of each attempt to merge together in their search for common ground and compromise. To arrive at a sense of clarity, we must look to those exceptions that define the fundamental system of rules at the heart of our nation’s health care structure, as the conflicting areas to be found within shed light on the vulnerabilities of the concept as a whole. The demands of federal statutes aside, gray areas abound, since attorneys can breach the duty of confidentiality in response to threats against life or to prevent substantial bodily harm, physicians must answer to certain matters of public health before protecting the secrets of the patient, and spouses can freely tell all when it comes to the actions of their partner, even if the words between them remain protected. … Read more →

Feb 8th, 2016 Administrative, Clinical, Community, Health Care Law, Health Care Reform, Hospitals, Lawyers, News, Non Clinical, Regulatory, Technology

The Health Care We Are Left With0

This article, The Health Care We Are Left With, was first published in Corporate Compliance Insights on January 6, 2016.

“Ending a sentence with a preposition is something up with which I will not put.” — Winston Churchill

Since the inception of the Affordable Care Act (the ACA) six years ago, the nation’s struggle over the proper provision of health care has been fought on many fronts, with both sides remaining passionately true to their convictions. As is the case with many of our nation’s historic battles, the American people may be remiss to disregard the impact of these struggles upon the evolution of our current health care structure. Like the January 3, 1777 Battle of Princeton during the American Revolution or the October 8, 1962 Battle of Perryville in the Civil War, many smaller events that appear understated or unimportant often have a long term impact. Instances where both patients and providers initially underestimated would-be tenets of the ACA can offer as much insight as outright Congressional mistakes in crafting the law. On the cusp of the iron anniversary for health care reform, this article offers examples of both the ACA’s shortcomings and successes. After all, too much of the planet’s most common element (at least by mass) can cause cirrhosis of the liver or arthritis, while a deficiency in iron can result in anemia. The following are topics that were resolved in 2015, as well as those for which 2016 may bring some clarity. … Read more →

Jan 6th, 2016 Administrative, Clinical, Health Care Law, Health Care Reform, Historical, Hospitals, News, Non Clinical, Regulatory