By JULIE APPLEBY

President Joe Biden counts among his accomplishments the record-high number of people, more than 21 million, who enrolled in Obamacare plans this year. Behind the scenes, however, federal regulators are contending with a problem that affects people’s coverage: rogue brokers who have signed people up for Affordable Care Act plans, or switched them into new ones, without their permission.

Fighting the problem presents tension for the administration: how to thwart the bad actors without affecting ACA sign-ups.

Complaints about these unauthorized changes — which can cause affected policyholders to lose access to medical care, pay higher deductibles, or even incur surprise tax bills — rose sharply in recent months, according to [Read More]

By SUSAN ADELMAN, MD
When I entered the medical profession 50 years ago, those were the good old days for doctors. Physicians enjoyed a windfall when Medicare and Medicaid were passed, then the appearance of new pharmaceuticals and surgical techniques enabled doctors to cure more conditions, which meant they had more lucrative business. Once regarded as poor, now doctors had the image of fat cats, rich targets to be taken down.

In 1993 the Clinton Healthcare Reform Task Force was in full throttle, and I had the dubious privilege of representing the AMA on a Healthcare Professionals Review Committee—not part of the Task Force, an afterthought.  The committee was created after I [Read More]

By KAITLYN DELBENE
Wachler & Associates, PC

The authority to revoke the Medicare billing privileges of enrolled providers is one of many program integrity tools used by the Centers for Medicare & Medicaid Services (“CMS”) to curb fraud, waste, and abuse in the federal healthcare programs. While CMS has generally stated that its revocation authority is intended to protect the Medicare program and its beneficiaries from overt abuse, ongoing expansions to the grounds for revocation have swept many well-intentioned providers into CMS’s crosshairs. Increasingly, relatively very small audit findings, e.g., amounting to $5,000 or less in alleged overpayments, if left un-appealed by the provider, are leading CMS contractors to pursue disproportionately [Read More]

By RALPH Z. LEVY, JR.
Dickinson Wright

My prior article addressed tax issues in repurchasing equity in physicians and other practice groups. This article provides information about drafting buy-sell agreements for practice entities that include provisions for repurchasing equity from owners. These agreements limit an owner’s ability to transfer equity and require its sale if employment terminates or the owner retires, becomes disabled, or dies. Buy-sell agreements also help the practice entity comply with state law requirements that only active practicing professionals can own equity in the entity.

Topic 1:  Structuring the buy-sell agreement

Since buy-sell agreements require its owners to transfer equity in the practice group upon termination of employment, death, disability, [Read More]

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

Cannabis Redo Could Open Up Michigan Industry

U.S. Attorney General Merrick Garland put forth a proposal to reclassify cannabis from a schedule I drug, along with heroin, to a schedule III drug, with some codeine combinations, which could change some rules in the Michigan industry.

Department of Justice Director of Public Affairs Xochitil Hinojosa said the proposal would need to be published by the federal register, which would then initiate the formal rule-making process. The Drug Enforcement Administration and DOJ had no further comment about a timeframe for the process or how long it could take.

Cannabis Regulatory Agency [Read More]

NOTE: The letter below appears partly in response to a story that appeared in the April 2024 edition of Healthcare Michigan.

EDITOR:

Any discussion of gun issues should begin with the reasons for and wisdom of the Second Amendment. The founders were quite clear on the rationale for this, so much so, that it was memorialized in the Constitution itself. Also rarely mentioned is the violence and even deaths prevented by armed law-abiding citizens.

Long lists of statistical data in a debate so immersed in political rhetoric, demagoguery and ideology should not be accepted as the final word. COVID has taught us that there are now two phrases that should evoke skepticism. They [Read More]

This story was originally published by ProPublica.

By ROBIN FIELDS
A new study challenged the accuracy of public health data on deaths related to pregnancy and childbirth — and the narrative of high and rising U.S. maternal mortality rates. An unusual public dispute has ensued.

Series: Lost Mothers: Maternal Care and Preventable Deaths

The U.S. has the highest rate of deaths related to pregnancy and childbirth in the developed world. Half of the deaths are preventable, victimizing women from a variety of races, backgrounds, educations and income levels.

An unusual public dispute has erupted among leading maternal health experts over whether the striking rise of U.S. maternal mortality rates over the past two decades was the [Read More]

By CHRISTINE SPOLAR

Gun violence has exploded across the U.S. in recent years — from mass shootings at concerts and supermarkets to school fights settled with a bullet after the last bell.

Nearly every day of 2024 so far has brought more violence. On Feb. 14, gunfire broke out at the Super Bowl parade in Kansas City, killing one woman and injuring 22 others. Most events draw little attention — while the injuries and toll pile up.

Gun violence is among America’s most deadly and costly public health crises. But unlike other big killers — diseases like cancer and HIV or dangers like automobile crashes and cigarettes — sparse federal money goes to [Read More]

By SUSAN ADELMAN, MD
When I was a surgery resident at Henry Ford Hospital, we greeted each patient on morning rounds in the same way. Good morning, Mr. Jones. Good morning, Mrs. Smith. How are you today? Or something like that. At least it was courteous and respectful. It did not matter if Mr. Jones was black or white, poor or rich. On our rounds, and in discussion of patients, staff doctors modeled color-blind treatment of their patients when they trained the residents. They even would call a child Mr. Jones, out of habit, then laugh, realizing it sounded silly. And Diversity, Equity, Inclusion training (DEI) had not been invented yet.

We [Read More]

By DANIEL AYYASH & SHEA MACE
Wachler & Associates, P.C.

Overview

In response to the enormous economic challenges faced by healthcare providers during the COVID-19 public health emergency (PHE), the Coronavirus Aid, Relief, and Economic Security (CARES) Act established the Provider Relief Fund (PRF) in an effort to provide financial support to providers across the nation. Congress allocated $178 billion to the PRF program, which was then disbursed to providers in multiple phases through general and targeted distributions. The Health Resources & Services Administration (HRSA), a subagency of the Department of Health and Human Services (HHS), was tasked with administering PRF disbursements and overseeing compliance with the program’s terms and conditions.

The primary [Read More]