Bill would create FCA protections for certain health care claims   08/01/2013
Reps. Howard Coble (R-NC) and David Scott (D-GA) today introduced the Fairness in Health Care Claims, Guidance and Investigations Act, AHA-supported bipartisan legislation that would amend the False Claims Act to assure that unintentional billing disputes in federal health care programs aren’t penalized as fraud. Federal agencies would have to review their own rules and regulations before launching an investigation to determine whether a billing dispute should be pursued as fraud. The legislation would raise the burden of proof for FCA health care claims from a “preponderance of the evidence” to a “clear and convincing evidence” standard, and remove billing disputes involving less than a threshold amount. It also would provide “safe harbors” under the law for providers who rely on information, audits or written statements from federal contractors or implement a federal model hospital compliance plan. Penalties for providers meeting the conditions in the bill would be limited to recoupment of any overpayment plus interest. “We applaud the leadership of Reps. Howard Coble and David Scott for introducing this important legislation and encourage quick passage by Congress,” said AHA Executive Vice President Rick Pollack.
AHA voices opposition to outpatient chemotherapy bill   08/01/2013
The AHA today expressed its opposition to the Medicare Patient Access to Cancer Treatment Act (H.R. 2869), introduced by Reps. Mike Rogers (R-MI) and Doris Matsui (D-CA). The bill significantly reduces payments to hospitals for cancer services. “The bill purports to ensure the availability of chemotherapy services by increasing the payments physicians receive to administer chemotherapy to cancer patients in private practice oncology clinics,” AHA Executive Vice President Rick Pollack said in a letter to members of Congress. “But the bill accomplishes this by actually cutting cancer treatment payments for hospital outpatient departments. By so doing, this misguided legislation will limit access to chemotherapy services for many cancer patients who now receive their treatment in the outpatient setting of their community hospital....Our goal is to ensure cancer patients continue to have access to care.”
AHA voices support for bill to improve safety of compounded drugs   08/01/2013
The AHA today voiced support for the Pharmaceutical Quality, Security and Accountability Act (S. 959), legislation to improve safety for patients receiving compounded drugs. “We believe that S. 959 is a step in the right direction and would go a long way toward addressing the current gaps in regulatory oversight of organizations that engage in compounding,” wrote AHA Executive Vice President Rick Pollack. “Hospital and health system pharmacies routinely compound medications for dispensing to their patients. Doing so is critical to high-quality and safe patient care. It is for this reason that we strongly support the included exception in the legislation which states that hospital and health system pharmacies that compound and ship drugs for dispensing to patients within facilities that are part of their organization, even if it involves interstate shipment, be regulated as traditional compounders under state oversight.” The Government Accountability Office yesterday issued a report recommending Congress consider clarifying the Food and Drug Administration’s authority to oversee drug compounding.
HHS seeks input to inform rulemaking on ACA non-discrimination requirements   08/01/2013
The Department of Health and Human Services’ Office for Civil Rights today published a request for information to inform its rulemaking for non-discrimination requirements under Section 1557 of the Patient Protection and Affordable Care Act, which prohibits discrimination in health care programs on the basis of race, color, national origin, sex, age or disability. This is the first time that federal law has prohibited sex discrimination in health care. The section took effect on passage of the ACA, and authorizes OCR to enforce the provisions and investigate potential violations. The requirements apply to health insurers, hospitals, health insurance exchanges and other entities that receive funds from federal health care programs. The RFI seeks information on individuals’ experience with various types of discrimination in health programs or activities, and covered entities’ experience in complying with federal civil rights laws. Comments will be accepted for 60 days.
GAO recommends action to address self-referral of IMRT services   08/01/2013
Congress should consider directing the Secretary of Health and Human Services to require providers to disclose their financial interests in Intensity-Modulated Radiation Therapy to their patients, the Government Accountability Office said in a report today. According to the report, the number of Medicare prostate cancer-related IMRT services performed by self-referring groups increased rapidly between 2006 and 2010, while declining for non-self-referring groups. The growth in services performed by self-referring groups was due entirely to limited-specialty groups, comprised of urologists and a small number of other specialties. GAO recommends that the Centers for Medicare & Medicaid Services insert a self-referral flag on the Medicare Part B claims form and require providers to indicate when a billed IMRT service is self-referred. In the report, HHS said the recommendation would not address the problem, but that a provision in the president’s fiscal year 2014 budget proposal would exclude certain services from the in-office ancillary services exception to the physician self-referral law to encourage more appropriate use of certain services.
CDC to host Q&A on reporting health care personnel flu vaccination data   08/01/2013
The Centers for Disease Control and Prevention will host a conference call Aug. 20 at 1:30 p.m. Eastern Time for health care providers reporting summary flu vaccination data for health care personnel to the National Healthcare Safety Network for the 2013-14 flu season. Hospitals participating in the inpatient quality reporting program must report on the health care personnel flu vaccination measures to receive a full payment update. Before the call, which will be a question-and-answer session, participants should view a recorded training session. For more on the training and to register for the call, click here.