By CHRISTINE WILLMSEN & MARTHA BEBINGER
The first nine months of 2013 started off as a banner year for the Sackler family, owners of the pharmaceutical company that produces OxyContin, the addictive opioid pain medication. Purdue Pharma paid the family $400 million from its profits during that time, claims a lawsuit filed by the Massachusetts attorney general.

However, when profits dropped in the fourth quarter, the family allegedly supported the company’s intense push to increase sales representatives’ visits to doctors and other prescribers.

Purdue had hired a consulting firm to help reps target “high-prescribing” doctors, including several in Massachusetts. One physician in a town south of Boston wrote an additional 167 prescriptions for [Read More]

By PAUL NATINSKY
When it comes to providing affordable basic healthcare, there is a group of entrepreneurial doctors poised to change the way healthcare is delivered: Direct Primary Care Physicians. These docs provide 80 to 90 percent of the healthcare their patients need for $50 to $70 per month. They offer prescription drugs and laboratory tests for up to 95 percent savings over what patients pay through insurance plans. They help negotiate discounted diagnostics like MRIs and colonoscopies and, in some cases help patients get lower cost visits with specialists. They see about half the patients of their insurance-model colleagues, but spend more time with each patient and offer unlimited visits [Read More]

Incoming Director Robert Gordon said early this month he believes there are “huge opportunities to improve services through the combination” of agencies that turned the Department of Health and Human Services into a huge 14,000-employee department.

“There are enormous connections between health and human services. People don’t live their lives in bureaucrat boxes,” he said in a telephone press conference today. “. . . I also know it is clear there is much more work to be done to leverage the combination and to get the full benefit.”

Gordon was appointed this month as the new DHHS director by Gov. Gretchen Whitmer. He most recently was senior vice president of finance and [Read More]

By EWA MATUSZEWSKI
We have a Code of Conduct and a Code of Ethics. Heck, for ONyou history buffs, we even have the Code of Hammurabi. Why don’t we have a Code of Compassion, though? More specifically, a Code of Empathy? It wouldn’t be limited to the healthcare profession, but I can’t think of a better place to begin the codification process.

Actually, a Google search did turn up a video on a code of empathy, but its views are relatively insignificant; plus, it was preceded in search findings by “coding with empathy” and “coding with compassion.” I think that means the door is open for a movement on empathy in healthcare.
Empathy [Read More]

By SARAH HILLEGONDS, ESQ.
Targeted probe and educate (TPE) audits are the latest type of audits facing Medicare providers and suppliers (collectively referred to as “providers”). TPE audits are unique in that providers may be subject to up to three rounds of record reviews. If a provider fails to improve the accuracy of their claims after three rounds, the provider will be referred to CMS for possible further action.

The Centers for Medicare and Medicaid Services initially launched TPE as a pilot program in one Medicare Administrative Contractor (MAC) jurisdiction limited to certain types of claims. In October 2017, CMS expanded TPE audits to all MACs for all Medicare providers and [Read More]

By ALLAN DOBZYNIAK, MD
One of the drivers of increasing health insurance policy premiums, and especially ACA policies, is the so called “community rating.” This is the concept that requires health insurance companies to offer policies within a given territory at the same price to all persons without medical underwriting, regardless of their health status. This does not account for all premium increases such as coverage mandates and increasing provider costs (almost exclusively attributable to hospitals), but it has become increasingly consequential. For the ACA, as the premiums increase fewer healthy people, particularly the younger, can afford the increasing premiums, or they may voluntarily choose not to purchase the more expensive [Read More]

By FEDERICO MARIONA, MD
The Michigan voters recently approved Proposal 1 by a margin of 56 to 44 percent. Retail for-profit sales of marijuana and related products is now the law in Michigan. Our state is the first state in the Midwest to take this step. Our neighbor Canada already has this in place. There are no neighboring states that have approved the use of marijuana for retail sales, yet.

Marijuana is a product from the flowers, stems, leaves and seeds of the plant (Phyto cannabinoids), and is the most common illicit drug used in the United States. Phyto active elements [Read More]

By THOMAS MILES, ESQ. & REESA N. BENKOFF, ESQ
On Nov. 26, 2018, the Office for Civil Rights (OCR), a division of the U.S. Department of Health and Human Services, announced that it had entered into a settlement agreement with Allergy Associates of Hartford, P.C. regarding alleged violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. The settlement requires Allergy Associates to pay the OCR $125,000 and enter into a two-year Corrective Action Plan. Allergy Associates, a physician practice with four office locations in Connecticut, is comprised of four physicians and two mid-level providers. Despite the seemingly low settlement figure, this fine relates to [Read More]

By SERJ MOORADIAN
Healthcare providers balance their time and resources between providing the best possible care to patients and keeping up with their ever-changing regulatory landscape. Providers are often at the mercy of the federal and state agencies that administer healthcare programs, which have significant discretion in interpreting statutes, promulgating rules and guidance that implement those statutes, and their enforcement. Due to the sheer number of applicable requirements, any provider that regularly bills a government healthcare program is likely to have an enforcement action brought against it by a government agency at some point, no matter how strong the provider’s compliance program is.

When an administrative agency takes [Read More]

By PAUL NATINSKY
Governor-elect Gretchen Whitmer has her work cut out for her. Despite historic gains for Democrats and women in Michigan and national midterm elections, Michigan’s legislature retains its Republican majority, and thus presents the new governor with an uphill challenge on all of her initiatives, including her healthcare plan, titled, “Get It Done: Healthy Michigan, Healthy Economy.”

The 19-page document covers a full range of issues facing a state that has low to middling marks on health status, access to care and the cost of healthcare services.

“The state of Michigan has invested very little in public health—just enough to meet what is needed to draw down federal funding,” stated Whitmer [Read More]