Birmingham Medical News: 2014 Health Care Year in Review

Articles / Publications

What can you say about a year that brought Ebola to the United States, record fraud and abuse recoveries, increased HIPAA investigations, Affordable Care Act changes, and a release of $77 billion in Medicare payment data. It's no wonder that many physicians are exploring the "safety" of hospital employment, or considering growth strategies to weather the storm of regulations, government oversight and constant change. It has been said, however, that with change there is opportunity. Perhaps one does not need to look any further than the shift in the Medicaid program to a managed care system to see a prime example of opportunity in the health care industry. So, with a look to the past year, following are my top ten 2014 health care events for Alabama providers.

10. New OIG Rules and Guidance. On May 9, the Office of Inspector General ("OIG") issued a proposed rule pursuant to the Affordable Care Act ("ACA") that significantly expands the OIG's exclusion authority. The proposed rule would allow the OIG to increase the time of exclusions and impose exclusions for audit related offenses and for making a false statement, omission or misrepresentation of a material fact in a federal health care program credentialing application. On September 19, the OIG issued a Special Advisory Bulletin, entitled Report on Manufacturer Copayment Coupons. Under the Bulletin, the OIG states that pharmaceutical manufacturers could be at risk of sanctions under the federal Anti-Kickback Statute by using coupons to fund copayments for drugs paid for by Medicare Part D. Finally, on October 2, the OIG proposed new safe harbor provisions to the federal Anti-Kickback Statute and expanded exceptions to the federal Beneficiary Inducement Civil Monetary Penalty Statute. The proposed rule addresses pharmacy rewards programs, Part D cost-sharing waivers by pharmacies, Medicare coverage gap discount programs, patient access to care with a low risk of harm, financial need-based exceptions, and cost-sharing for the first fill of a generic drug.

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