Two Democratic-led Senate committees in June adopted a report projecting that the U.S. House Republicans’ proposed Medicaid reforms will create a $2 billion hole in the state budget and drop more than 500,000 beneficiaries due to new paperwork or eligibility obligations.

The report was adopted by the Senate Health Policy Committee, as well as the Senate Appropriations Subcommittee overseeing Michigan’s Department of Health and Human Services. For Sen. Kevin Hertel (D-St. Clair Shores)’s health policy committee, the report was accepted into the panel’s record through an unopposed motion without a roll call vote.

Meanwhile, for Sen. Sylvia Santana (D-Detroit)’s appropriations subcommittee, the report was adopted along partisan lines.

While speaking to MIRS, Santana confirmed the report was more about raising the alarm around the potential impacts of restricting Medicaid on the federal level, as opposed to auditing how the state spends its Medicaid funding.

The report highlighted that on average, Medicaid patients make up 22 percent of hospital patient volume in Michigan. Before the state expanded Medicaid eligibility under Republican Gov. Rick SNYDER, childless adults in the state could earn no more than 35 percent of the Federal Poverty Level (FPL) to receive some Medicaid benefits.

In 2014, it was offered to all adult Michiganders earning under 139 percent FPL, [Read More]

By ARTHUR ALLEN

Within an hour of receiving a COVID vaccination in November 2020, Utah preschool teacher Brianne Dressen felt pins and needles through her arms and legs. In the medical odyssey that followed, she suffered double vision, chronic nausea, brain fog, and profound weakness. Once a rock climber, she became a couch potato.

Although Dressen’s symptoms were rare in that season of hundreds of millions of COVID vaccinations, they were common enough to draw the attention of a National Institutes of Health neuroscientist named Avindra Nath, who examined Dressen and more than 30 other people with a similar syndrome in 2021. He recommended Dressen take steroids and antibodies — treatments that saved her life, she said.

And then, according to emails reviewed by KFF Health News, Nath said he couldn’t help anymore. His clinical study was ending. He directed the patients to seek local help. But, Dressen said, there wasn’t any.

Nath declined to speak to KFF Health News for this article. The FDA searched international vaccine safety databases for small-fiber neuropathy, one of the most common symptoms he mentioned in a write-up of the patients, and found it was less prevalent in vaccinated than in unvaccinated patients, said Peter Marks, who led the FDA division responsible for vaccines [Read More]

By JENNI COLAGIOVANNI & ERIN LIECHTY
Wachler & Associates, P.C.

On May 21, 2025, CMS announced its plan to significantly expand audit efforts of Medicare Advantage (MA) plans. CMS’ expanded audit effort is two-fold: (1) audit all eligible MA contracts for all newly initiated audit payment years, and (2) expedite audits from payment years 2018 to 2024. The Trump administration is turning its attention to these plans because it is estimated that MA plans have overbilled the government between $17 billion and $43 billion annually and because despite the vast overpayment suspected there has been no concerted effort to audit these plans since 2007.

CMS’ MA audit expansion plan is comprised of the use of enhanced technology, workforce expansion, and increased audit volume. CMS states it will use “advanced systems” to find unsupported diagnoses. It is reasonable to assume this may take the form of an AI-driven program to flag unsupported diagnoses presumably for closer review, though CMS has not yet provided the specifics of this enhanced technology. Furthermore, CMS reports that by September 1, 2025, the number of medical coders who manually verify the flagged diagnoses will increase from 40 to 2,000. With these changes, CMS aims to have the capacity to audit all of the [Read More]

By RALPH LEVY
Dickinson Wright

Although in prior articles in this publication, I addressed tax issues faced by physicians and other practice groups, the purpose of this article is to guide physicians and other medical professionals as they compare the taxes payable by them under completing offers to join practice groups. These tax consequences will vary depending on several factors, including whether the offer includes equity ownership and whether or not the group is organized as a professional corporation.

Suppose the offer is for employment without an ownership interest in the practice group, regardless of whether the employer is organized as a professional corporation (PC) or as a professional limited liability company (PLLC). In that case, the tax consequences of cash compensation paid to the employed professional will be the same. The hired professional will be taxed on all cash compensation, including bonuses at ordinary income rates, and Social Security and Medicare taxes will be deducted by the employer. Employees are responsible for Social Security taxes on all annual cash compensation of 6.2% up to the contribution and benefit base for that year ($176,100 for 2025). This means that the maximum Social Security taxes that the employed physician or other professional will pay is $10,918.20 for 2025. In [Read More]

AG Reaches Agreement To Clean Up PFAS-Contaminated Materials

Attorney General Dana Nessel has reached a settlement agreement with Domtar Industries and E.B. Eddy Paper to address releases of per- and polyfluoroalkyl substances (PFAS) at the Techni-Comp Inc. composting site near Port Huron.

Under the terms of the settlement, Domtar has agreed to remove compost piles containing sludges contaminated with PFAS at the site and dispose of the contaminated material in a licensed landfill. In addition, Domtar will investigate PFAS in sediments in surface waters at the site.

The settlement, entered as an enforceable Consent Decree by the 31st Circuit Court in St. Clair County on June 20, includes a $300,000 payment to the Department of Environment, Great Lakes, and Energy (EGLE) to conduct additional response activities to address PFAS at the site. Domtar will also cover the state’s past oversight costs and costs of litigation, including attorney fees.

Nessel filed a lawsuit against the paper manufacturer in December 2022, and it was brought under a state-approved contract with special assistant AGs retained specifically to assist with complex PFAS litigation.

There are currently four PFAS cases filed under the SAAG contract that are pending in both state and federal court.

Gun Bans On Bump Stocks, Ghost Guns, Carrying In The Capitol Pass Senate

Senate Democrats [Read More]

By ELISABETH ROSENTHAL
Health care has proved a vulnerable target for the firehose of cuts and policy changes President Donald Trump ordered in the name of reducing waste and improving efficiency. But most of the impact isn’t as tangible as, say, higher egg prices at the grocery store.

One thing experts from a wide range of fields, from basic science to public health, agree on: The damage will be varied and immense. “It’s exceedingly foolish to cut funding in this way,” said Harold Varmus, a Nobel Prize-winning scientist and former director of both the National Institutes of Health and the National Cancer Institute.

The blaze of cuts have yielded nonsensical and perhaps unintended consequences. Consider instances in which grant funding gets canceled after two years of a three-year project. That means, for example, that $2 million has already been spent but there will be no return on that investment.

Some of the targeted areas are not administration priorities. That includes the abrupt termination of studies on long COVID, which afflicts more than 100,000 Americans, and the interruption of work on mRNA vaccines, which hold promise not just in infectious disease but also in treating cancer.

While charitable dollars have flowed in to plug some gaps, “philanthropy cannot replace federal funding,” [Read More]

A massive tax cut/Medicaid reform bill that cleared the U.S. House this month has sparked a messaging war at all levels of politics between Republicans and Democrats attempting to frame the issues for the public.

For Republicans, the “One Big Beautiful Bill” makes tax cuts from President Donald Trump’s first term permanent, but for Democrats, the changes to how Medicaid is administered mean “people will die.”

All the while, both sides are sidestepping the significant debt that comes with the plan, which still needs U.S. Senate approval to get to Trump’s desk.

U.S. Reps. Debbie Dingell (D-Dearborn), Haley Stevens (D-Birmingham) and Gov. Gretchen Whitmer took aim at the cuts the bill would administer to Medicaid and the Supplemental Nutrition Assistance Program (SNAP). The Congressional Budget Office shows Medicaid spending would be reduced by $700 billion and SNAP spending would be reduced by about $276 billion over 10 years.

“People will die, children will go hungry, and working Americans will continue to struggle to make ends meet, all so Republicans can give another tax break to billionaires,” Dingell said in a press release.

State House Democrats also held a press conference railing against the passage of the federal reconciliation bill with Reps. Ranjeev Puri (D-Canton), Stephanie A. Young (D-Detroit) and Jennifer [Read More]

By KAITLYN DELBENE
Wachler & Associates, PC

A press release from the U.S. Department of Health and Human Services on March 27, 2025, announced a self-described “dramatic restructuring” of the Department as part of the administration’s efforts at “workforce optimization.” Among other changes, the press release revealed a plan to slash the HHS workforce by 25 percent and announced oversight of certain HHS offices by a new Assistant Secretary for Enforcement. As these sweeping changes are implemented, providers should be aware of possible ramifications for their practices. The cuts to the HHS workforce have been challenged in a lawsuit by 21 states and the District of Columbia, though no injunction has yet been sought or ordered; in the meantime, the organizational restructuring—including the consolidation of 28 agencies into 15—is likely to be felt by Medicare providers interacting with HHS on policy, regulation, enrollment, and audit matters.

New Approach to Enforcement
HHS announced that it will create a new Assistant Secretary for Enforcement to oversee the Departmental Appeals Board (DAB), Office of Medicare Hearings and Appeals (OMHA), and Office for Civil Rights (OCR) in order to “combat waste, fraud, and abuse in federal health programs.” No further detail has yet been provided as to the Assistant Secretary role or whether [Read More]

Healthcare Michigan – Michigan’s 21st Century Healthcare News Source

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

UIA Director Testifies In Oversight Subcommittee About $8-$15 Billion In Fraud During COVID-19
The House Oversight Subcommittee on State and Local Assistance Programs heard testimony from Michigan Unemployment Insurance Agency (UIA) Director Jason Palmer over the agency’s handling of pandemic-era unemployment benefits, which resulted in an estimated $8 to $15 billion in overpayments.

The meeting focused on two reports from the Office of the Auditor General (OAG) that detailed widespread fraud, mismanagement, and systemic failures within the UIA during the COVID-19 pandemic. Palmer, who took over the office just 86 days prior, acknowledged the agency’s past failures and pledged full cooperation with the committee to prevent future fraud.

“I own it now,” Palmer said, affirming his commitment to reform, despite not leading the agency during the time of the problem.
“We are building an agency that doesn’t just react to crisis, but delivers reliably every day,” said UIA COO Brett Gleason.

The committee scrutinized the UIA’s decision to disable its “Fraud Manager” software early in the pandemic, a move that coincided with a surge in fraudulent claims. According to the Deloitte audit cited during the hearing, the agency saw a $2.5 billion drop in likely impostor claims [Read More]

(ROYAL OAK) – Michigan’s health department was assigned to craft a report detailing the impact of potential future federal Medicaid cuts as part of an executive directive Gov. Gretchen Whitmer penned this month at a press event at Beaumont University Hospital.

The U.S. House is considering up to $880 billion in Medicaid cuts over 10 years, which KFF (formerly the Kaiser Family Foundation) projects represents 29 percent of state-financed Medicaid spending per resident, to cover the costs of extending tax cuts President Donald Trump signed in 2017.

U.S. Rep. Debbie Dingell (D-Dearborn) said House Republicans have circled May 7 on the calendar as the day they will roll out more details on the reductions, which she said is not about presenting a balanced budget.

The tax cuts in question come from the Tax Cut and Jobs Act (TCJA) of 2017, which lowered individual income tax rates and increased standard deductions, but also lowered the corporate income tax from 35 percent to 21 percent.

Also joining Whitmer in the hospital’s serene sixth floor atrium were U.S. Reps. Haley Stevens (D-Birmingham) and Rashida Tlaib (D-Detroit), as well as Dr. Dan Carey, president of Corewell Health William Beaumont University Hospital and several other white coats.

Medicaid is the third-largest mandatory program in the federal budget, accounting for 9 percent of federal [Read More]

Nearly nine years ago, Faith Brown watched her armed husband kill her four children after she served him divorce papers. Now she visits the Capitol with a funding request to legislators, saying Michigan’s newest gun laws won’t protect domestic violence survivors if shelters close.

“He killed our four children in front of me. He shot me, cut me with a knife and left me for dead. What was so chilling was how calm he was. He wasn’t angry. He didn’t yell. He just did it,” Brown said. “I remember waking up in the hospital. A social worker gave me a folder with resources to try to help me put my life back together. I still have that folder.”

On April 22, around 100 individuals gathered behind the Capitol to kick off the “Team Enough” lobby day, calling for various firearm reforms.

Some of today’s policy requests were intended to build off statutes adopted by the previously Democratic-controlled state government in the 2023-24 term. For example, in May 2023, the governor signed off on creating Extreme Risk Protection Orders (ERPOs), so family members, spouses and romantic partners could petition the courts to have someone’s guns temporarily confiscated.

Later, in November 2023, the governor signed legislation banning individuals convicted of misdemeanor domestic violence [Read More]

By DANIEL AYYASH & KELSEY CLAUSS
Wachler & Associates, P.C.

Healthcare providers are well aware of the complexities and demands of Medicare audits and the havoc they can wreak. However, with careful billing, attention to detail, and thorough documentation, it is possible to turn the tide. However, a recent trend indicates that Medicare audits are being scrutinized much more closely and are quickly evolving into something far more serious—an investigation under the False Claims Act (FCA).

The Medicare audit process typically involves a review of healthcare claims, medical records, billing codes, and supporting documentation. When alleged discrepancies are found—such as improper coding, overbilling, inaccurate claims, or inadequate documentation—providers may face overpayment allegations, repayment demands, and other related consequences, usually contained within the administrative Medicare framework and not escalated to a matter under the FCA… Until now.

What is the False Claims Act (FCA)?

The FCA is a powerful federal law designed to hold individuals and organizations accountable for submitting fraudulent or false claims for payment from the government. Originally introduced to address unscrupulous government contractors during the Civil War, the FCA has become a popular tool for prosecuting alleged healthcare fraud. Generally, the FCA imposes civil liability for knowingly submitting false claims to the government. The FCA also allows individuals [Read More]

By LEE G. PETRO & KIMBERLY RUPPEL
Dickinson Wright

The future of healthcare once seemed like science fiction—think of The Jetsons, the iconic 1960s animated show where families communicate via video calls and receive virtual checkups. But today, telehealth has rapidly become a reality, thanks to technological advances and broadband expansion. However, key funding mechanisms are now under scrutiny, raising questions about whether this future will continue to grow or stall.

Recent advancements in broadband infrastructure have fueled the rapid expansion of telehealth services. Underpinning this significant growth has been the expansion of the broadband infrastructure over the past five years to ensure that healthcare providers and patients have reliable communications services. However, two significant government actions last week could impact future funding and accessibility.

First, oral arguments were heard on March 26 by the Supreme Court regarding challenges to the Universal Service Fund (“USF”) Program. The USF Program is overseen by the Federal Communications Commission (“FCC”), which delegates the day-to-day operations of the USF Program to the Universal Service Administrative Company (“USAC”). Under the supervision of the FCC, USAC collects mandatory contributions from telecommunications carriers. The contributions fund several subsidy programs, including the Rural Health Care Program. This Program assists eligible healthcare entities in connecting with affordable telecommunications and broadband services. [Read More]

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

El Sayed Handing Out Grades To Kennedy

The former director of the Detroit and Wayne County health departments is awarding two grades to the new federal health director, RFK, Jr.

Dr. Abdul El-Sayed gives Robert F. Kennedy Jr. an A for focusing on the major nutrition problem facing this country, but a D for suggesting the wrong solution.

“He is bringing attention to the long-term problem of nutrition in an industry dominated by huge corporations producing the wrong kinds of foods that are ultra-processed and delivered in ways just to get us to consume more (and) he defines the problem and then brings the wrong solution chaotically and ham-handed to be executed, usually for his own gain.”

Interviewed on Off the Record the day after tossing his hat back into the statewide elective ring, this time for the U.S. Senate, El-Sayed hit a number of bullet points.

– “I don’t second-guess somebody else’s decision-making,” regarding Gov. Gretchen Whitmer’s strategy to work with President Trump when she can.  “A governor’s role is different from what a senator’s role might be,” the former Democratic gubernatorial candidate observed.

– He conceded that President Donald Trump won the “young man disaffected” vote in 2024. El Sayed has a strategy [Read More]

By PAUL NATINSKY
Like the rest of the cuts by chainsaw, the 15-percent cap on indirect costs for National Institutes of Health projects is a sharp-edged reduction in spending. Purportedly targeted at reducing waste and inefficiency, the indiscriminate reduction belies that mission.

The most rudimentary of analyses would have proved the approach infeasible. About $9 billion of the NIH’s $35 billion in grants for 2023 were for indirect costs, which include equipment and office space, technology, research security, data processing, biosafety, financial and accounting support, and legal and compliance support. Indirect costs average around 28%, with some over 60%, according to NIH-reported numbers. The costs are negotiated on a project-by-project basis.

The proposed cuts, which remain under legal challenge, would stop many projects in their tracks. Twenty-two states immediately filed suits in federal court after Trump administration rolled out its plan in early February.

“The NIH funding cuts that were peremptorily imposed (and then stopped by the courts) are terrible for the University and even more so for the state of Michigan and for all of our citizens,” said Marianne Udow-Phillips, a lecturer at the University of Michigan School of Public Health, who has worked in a number of roles during a long career in health policy in Michigan.

The [Read More]

By PATRICIA CALLAHAN

This story first appeared in ProPublica, a nonprofit newsroom that investigates abuses of power.

Leaders at the Centers for Disease Control and Prevention ordered staff this week not to release their experts’ assessment that found the risk of catching measles is high in areas near outbreaks where vaccination rates are lagging, according to internal records reviewed by ProPublica.

In an aborted plan to roll out the news, the agency would have emphasized the importance of vaccinating people against the highly contagious and potentially deadly disease that has spread to 19 states, the records show.

A CDC spokesperson told ProPublica in a written statement that the agency decided against releasing the assessment “because it does not say anything that the public doesn’t already know.” She added that the CDC continues to recommend vaccines as “the best way to protect against measles.”

But what the nation’s top public health agency said next shows a shift in its long-standing messaging about vaccines, a sign that it may be falling in line under Health and Human Services Secretary Robert F. Kennedy Jr., a longtime critic of vaccines:

“The decision to vaccinate is a personal one,” the statement said, echoing a line from a column Kennedy wrote for the Fox News website. [Read More]

By JESSE ADAM MARKOS, ESQ.
Wachler & Associates, P.C.

Michigan is currently facing a shortage of physicians, especially in the state’s many rural and underserved areas.  In response, efforts are being made to remove barriers to entry for high-quality providers, like the often-confusing licensing process across state lines.  More specifically, the Michigan Legislature has recently taken action to renew Michigan’s standing as part of the Interstate Medical Licensure Compact (“ILMC”) and to ensure that it can remain within the compact permanently.  The ILMC streamlines the licensing process for physicians seeking to practice across state lines and has proven successful in increasing access to care.  However, Michigan’s participation in the compact is currently set to expire March 28, 2025 and lawmakers must move quickly before it expires.

Michigan first joined the ILMC in 2018 when Governor Snyder signed Public Act 524 of 2018 and Public Act 563 of 2018, making Michigan the 25^th state to join compact.  Currently, 35 states participate as members.  The ILMC allows physicians who are licensed in other member states the ability to get licensed easier in Michigan based on having a compact license.  It also allows Michigan physicians to get licensed easier in other member states.

Pursuant to the ILMC, a licensed physician in Michigan [Read More]

By NICOLETTE TABER
Dickinson Wright

On January 17, 2025, the U.S. Departments of Labor, Health and Human Services, and the Treasury (“the Departments”) issued their 2024 Report to Congress on the enforcement and implementation of the Mental Health Parity and Addiction Equity Act (“MHPAEA”). This regularly required report follows the Departments’ Final Rules issued in September 2024. (For more information on the September 2024 Final Rules, click here to read my previous article on this topic).

The 142-page report to Congress highlights the Departments’ efforts to strengthen and enforce the protections of MHPAEA, the Departments’ efforts to raise awareness of MHPAEA by working with federal and state partners, and areas of improvement for plans and issuers. Notably, the report reviews the enforcement efforts performed by the Department of Labor’s Employee Benefits Security Administration (“EBSA”) and the Department of Health and Human Services’ Centers for Medicare & Medicaid Services (“CMS”) and their impact on the Departments’ efforts to effectuate mental health parity.

EBSA has primary enforcement jurisdiction over MHPAEA for approximately 2.6 million private, employment-based group health plans covering roughly 136 million Americans. Nearly 25 percent of its enforcement program focuses on MHPAEA nonquantitative treatment limitations (“NQTL”). CMS has enforcement authority over approximately 91 thousand non-federal governmental plans [Read More]

Possible Federal Cuts To Medicaid, Education Always On Flood’s Mind

State Treasurer Rachael Eubanks and State Budget Office Director Jen Flood said they have been watching the federal government “daily” to see if any changes could hit what the state expects in their 2026 budget.

Speaking at an Institute for Public Policy and Social Research (IPPSR) event, Flood said she has seen proposed federal cuts to nearly $900 million in Medicaid funding and a possible 10 percent removal from education in federal grant funding because of the dismantling of the U.S. Department of Education.

“I can say Medicaid is on my mind every day right now. Michigan is one of the states that actually draws down more federally than a lot of others,” Flood said.

She said the federal government was looking to wrap up reconciliation before Easter, but she didn’t know if or when it would happen.

“Hopefully these changes are out away, so we have some time to figure out how it would impact the state, but we’ve got to start preparing for different scenarios,” she said.

Flood said Gov. Gretchen Whitmer’s current budget still stood because there were no federal changes that had been passed federally. If that happened, it would cause a “recalibration” of the budget, even if it [Read More]

By PAUL NATINSKY

As Robert F. Kennedy eases into the Health and Human Services director’s chair, his flashpoints and shortcomings are widely publicized, but lightly opposed.

Kennedy’s skeptical views on vaccine effectiveness and safety, fondness for fringe conspiracy theories and likely embrace of deep Medicaid cuts have the healthcare community and many policymakers concerned about the new secretary’s public health stewardship.

Kennedy’s lack of administrative acumen looms large as he assumes control over a department that employs 80,000 and oversees a $3 trillion annual expenditure representing 22.8% of the U.S. federal budget.

Kennedy lacks managerial experience at organizations even a small fraction of that size. HHS is responsible for the care of 140 million Americans. That number is largely made up of the country’s most vulnerable citizens, including people too poor to afford to buy health insurance, those whose employers don’t offer coverage, and people over age 65 or who have disabilities.

Yet, despite these glaring warning signs, the healthcare community is oddly silent or seemingly eerily reassured.

Nationally, the online news outlet Politico could round up only a handful of healthcare insiders to comment under a veil of anonymity. Only the American Public Health Association spoke on record.

“They think he’s the wrong person for the job,” Dr. Georges Benjamin, executive [Read More]

By PHIL GALEWITZ

Medicaid is under threat — again.

Republicans, who narrowly control Congress, are pushing proposals that could sharply cut funding to the government health insurance program for poor and disabled Americans, as a way to finance President Donald Trump’s agenda for tax cuts and border security.

Democrats, hoping to block the GOP’s plans and preserve Medicaid funding, are rallying support from hospitals, governors, and consumer advocates.

At stake is coverage for roughly 79 million people enrolled in Medicaid and its related Children’s Health Insurance Program. So, too, is the financial health of thousands of hospitals and community health centers — and a huge revenue source to all states.

On Feb. 13, the House Budget Committee voted to seek at least $880 billion in mandatory spending cuts on programs overseen by the House Energy and Commerce Committee. That committee oversees Medicaid, which is expected to bear much of the cuts.

Senate Republicans, working on their own plan, have not proposed similar deep cuts. Sen. Ron Wyden of Oregon, the Finance Committee’s top Democrat, said he expects “an effort to keep the Medicaid cuts hidden behind the curtain, but they’re going to come sooner or later.”

Since Trump took office, Republicans in Washington have discussed making changes to Medicaid, particularly by requiring [Read More]

By AMY MAXMEN

Some private schools have shut down because of a rapidly escalating measles outbreak in West Texas. Local health departments are overstretched, pausing other important work as they race to limit the spread of this highly contagious virus.

Since the outbreak emerged three weeks ago, the Texas health department has confirmed 90 cases with 16 hospitalizations, as of Feb. 21. Most of those infected are under age 18. Officials suspect that nine additional measles cases reported in New Mexico, across the border from the epicenter of the Texas outbreak in Gaines County, are linked to the Texas outbreak. Ongoing investigations seek to confirm that connection.

Health officials worry they’re missing cases. Undetected infections bode poorly for communities because doctors and health officials can’t contain transmission if they can’t identify who is infected.

“This is the tip of the iceberg,” said Rekha Lakshmanan, chief strategy officer for The Immunization Partnership in Houston, a nonprofit that advocates for vaccine access. “I think this is going to get a lot worse before it gets better.”

An unknown number of parents may not be taking sick children to clinics where they could be tested, said Katherine Wells, the public health director in Lubbock, Texas. “If your kids are responding to fever reducers and [Read More]

By STEPHEN SHAVER
Consultant, Wachler & Associates PC

Nearly every third-party payor of claims for healthcare services – Medicare, Medicaid plans, commercial insurers, etc. – will at some point request that the billing provider submit copies of the documentation and medical records that support the services billed. In these circumstances, an ounce of prevention is often worth a pound of cure. The payor will often make decisions regarding coverage and overpayment allegations based on the records submitted by the provider. The provider can proactively address or even prevent many disputes by careful attention to their response to the medical records request.

First, a provider should be aware of what entity issued the request, what specific records it has requested, and for what purpose. For example, a Medicare Unified Program Integrity Contractor (“UPIC”) is charged with investigating allegations of fraud within the Medicare program and may conduct a records review differently from other Medicare contractors. The Special Investigation (“SI”) unit or team at many commercial insurers serves much the same function. The provider is generally required to comply with the request for records, whether by law, regulation, or contractual agreement. It is, therefore, important to carefully review the record request and provide documentation that is responsive. Where the request [Read More]

By ERICA ERMAN
Dickinson Wright

Can you remember healthcare security 20+ years ago? It seems like a different world from now. Believe it or not, the HIPAA Security Rule has barely changed since it was first enacted in 2003[1]and has been long overdue for a significant remodel. Read on for highlights of the proposed new Security Rule and action items.

A Very Brief HIPAA History

 As a quick background, the HIPAA Security Rule was first penned in large part to create minimum security standards for electronic protected health information (ePHI) and to protect patients’ rights over their healthcare data. The Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009 added the now well-known Breach Notification Rule as well as other significant changes in an effort to protect patient information. As healthcare professionals well know, much of the onus of protecting that information has fallen on HIPAA-covered entities and providers.

Questions, Concerns, Complaints – Comment Period Is Open

On January 6, 2025, the proposed new HIPAA Security Rule was added to the Federal Register. For any of our readers interested in filing comments to the proposed rule, please note that the comment period is open until March 7, 2025 (60 days after the proposed rule was [Read More]