Archive for February, 2013

The Affordable Care Act: A Not-So-Little Train That Must

This article was first published in the Los Angeles Daily Journal on February 25, 2013.

“Things do not change. We change.”  - Henry David Thoreau

Finally free from the uncertainty of looming elections or Supreme Court decisions questioning consititutionality, modern American health care can now be compared to a speeding train serving infinite destinations, with conductors and passengers alike learning the routes along the way. Public transportation is usually forgiving, as the tardy or confused passenger always has the opportunity to catch the next train, but such is not always true in matters of public health.  Whether fan or foe of the Affordable Care Act (the ACA), this epic codification of health care reform is something that America cannot afford to miss.

At the time the ACA was passed in March 2010, by a margin of seven of the collective 431 Congressional votes, few of those involved had any real working knowledge of the 10,909 sections contained within the Patient Protection and Affordable Care Act, which were quickly adjusted and finalized by congressional changes the following week in the form of the Health Care and Education Reconciliation Act. Weighing in at over 900 pages, hindsight makes it clear that the ACA was only the beginning of the federal government’s plan to restructure the nation’s health care system, a fact that has been compounded by an estimated 70,000 pages of further regulations in the three years since President Barack Obama signed the ACA into law. Continue reading →

CCOs to Use Tools of Trade in New Payment Models, Delivery Systems

This article was first published on February 18, 2013 at AISHealth.

Compliance officers are starting to apply the tricks of their trade to new payment models and health care delivery systems.To keep up with the major transformations rippling through the industry, some compliance officers will need to monitor datathat are used to evaluate their health systems’ performance, tap into new resources and work more closely with finance,revenue cycle and other departments, experts say.

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More hospital revenue will depend on its performance on quality, value and patient satisfaction measures, which impactsthe way compliance officers identify risks. “Establishing a link between finances and compliance makes sense becauseperformance is now integral to compliance,” said attorney Craig Garner, who spoke at a recent Health Care ComplianceAssociation webinar. Continue reading →

Return of the Hall Monitor

Say Hello to the Chief Compliance Officer at a Pharmaceutical Company Near You

This article first appeared in Pharmaceutical Compliance Monitor on February 11, 2013.

As any teenager will tell you, nobody likes a snitch. When it comes to the antics of the adolescent, rarely is unwanted disclosure or unsolicited intervention met with appreciation.  And yet, in observing the conduct displayed recently throughout many fields in our nation’s business sector, similar sentiment rang true across corporate America, and the moral “high road” was rarely found to intersect with the path most traveled. The health care industry was no different, and any strict constructionist interpretation of the Hippocratic Oath usually limited “do no harm” to the delivery of patient care in its most literal sense, foregoing the machinations conspiring behind the scenes to keep a hospital’s doors open in the face of a souring economic climate.

Now Is the Time for Compliance

The ethical transformation in health care that gained momentum one score and seven years ago has its origins in a law signed on March 2, 1863, by the president famous for the words “four score and seven years ago” uttered that same year.  The False Claims Act (the “FCA”), also known as “Lincoln’s Law” and the “Informer’s Act,” has evolved considerably since its enactment to become the “primary litigative tool for combating fraud” (see S. Rep. 99-345, at 2 (1986)).  Continue reading →

The Poor Get Poorer: The Fate of Distressed Hospitals Under the Affordable Care Act

This article, written by Samuel R. Maizel and Craig Garner, first appeared at 2012 No. 12 Norton Bankr. L. Adviser 1 in December 2012. 


Distressed hospitals in America operate on small or non-existent profit margins.3 For many of those hospitals, the federal Medicare program and the individual States’ Medicaid programs are the largest payors. While the Patient Protection and Affordable Care Act of 2010 (the “Affordable Care Act”) was designed in part to increase the number of insured nationwide, the result of which should be positive for hospitals, any cause for celebration must first address the cost containment provisions in the Affordable Care Act that create new concerns for financially distressed hospitals. Included among the multitude of provisions in the Affordable Care Act are an immediate 1% cut in Medicare revenue, phased in reductions in disproportionate share payments to hospitals, future, permanent penalties of up to 1% of Medicare payments for hospitals which perform poorly under the Hospital Value Based Purchasing Program, and additional penalties for hospitals with unacceptable rates of re-admission or too many hospital acquired conditions rates.4 Together these cuts create a daunting challenge for the many financially distressed hospitals in America that simply lack the resources to establish an infrastructure designed to treat Medicare patients in this era of change.


Medicare is the federal program that provides health care coverage to individuals aged 65 or older. Medicaid offers similar access for medical services on a state level for qualifying individuals, many of whom are poor. Medicaid covers 69 million people.5 By 2020, under the Affordable Care Act the number of Medicaid beneficiaries is likely to increase to 93 million.6 Combined, Medicare and Medicaid pay for more than half of the annual hospital bills in America. Continue reading →


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