By ERIN DIESEL ROUMAYAH, ESQ.
On Nov. 3, 2017 the Centers for Medicare and Medicaid Services and the Office of Medicare Hearings and Appeals (OMHA) (the division of the U.S. Department of Health and Human Services that administers the Medicare appeals process) announced two new settlement opportunity for Medicare Part A and Part B providers and suppliers with eligible fee-for-service appeals pending in the administrative appeals process. These new programs are the Low Volume Appeals Settlement (LVA) and the expanded Settlement Conference Facilitation program (SCF). CMS offered LVA as a lump-sum settlement offer for eligible Appellants with certain eligible appeals. SCF affords eligible Appellants an opportunity to negotiate a lump-sum [Read More]

By ERICA MORRIS & MARK WILSON
How can providers increase quality of care while reducing cost to patients? The answer is through innovation, creativity, increased patient responsibility, partnership, and real-time flow of information. Here are just a few ideas to consider in reaching this overarching goal. While none of the ideas articulated below are novel or groundbreaking on their own, they are strategies that we have observed to be successful and that have benefited both patients and practices.

Encourage Your Patients to Be Involved in Their Healthcare Decisions—Both Procedurally and Financially

One of the keys to bringing costs down and letting the competitive consumer market assist in the process is having [Read More]

By SUSAN ADELMAN, MD
As the endless dispute about reforming healthcare drags on in Washington, the participants might want to note two articles that appeared in the daily AMA Morning Rounds on February 9, 2018:

The first references several state-requested innovations to Medicaid:
Quoting the Congressional Quarterly, “in addition to work requirements,… several states “want to impose time limits on how long people can stay on the program.” A couple of states “want to roll back their Medicaid expansions to cover fewer people,” and still others would like “to require drug testing or limit the list of prescription drugs they’ll pay for…”

The press already has reported on some of these proposed work requirements. [Read More]

By ALLAN DOBZYNIAK, MD
Could it be that medical care is now taken for granted? Are the fantastic technologies, miracle drugs, futuristic hospitals, and finally even doctors now simply viewed as facts of nature, things that were always there and will always be there? Is there the expectation that doctors will forever improve the quality of life and add years to it?

Could it be possible that government intervention into healthcare was the origin of the concept that patients need do nothing to earn their medical care and even presume perfection and cures? All they needed to do was wish it, demand it, and the government would decree that it happen. Could [Read More]

State Permanently Yanks Nassar’s Medical License, Docks Him $1M

The state April 6 permanently revoked the medical license of Larry Nassar and fined him $1 million, making it the largest fine ever issued by a health professional or occupational board in the history of the Michigan Department of Licensing and Regulatory Affairs (LARA), according to the department.

Nassar, the former physician for Michigan State University and team doctor for U.S.A. Gymnastics, has been sentenced to federal prison on child pornography possession charges. He was sentenced to state prison on numerous counts of criminal sexual conduct, stemming from his sexual abuse of hundreds of women, often under the guise of medical treatment.

The state’s [Read More]

By SHEFALI LUTHRA
When President Donald Trump signed the last-minute budget deal into law earlier this month, the news coverage emphasized how the bill boosted military funding, provided tens of billions in disaster aid and raised the debt ceiling.

But buried deep in the 652-page legislation was a repeal of a limit on Medicare coverage of physical and occupational therapy. It received little public attention, but to the American Physical Therapy Association, this headline was decades in the making.

The group had spent 20 years lobbying to reverse a component of the Balanced Budget Act of 1997, which would have limited patients to $2,010 worth of occupational therapy a year, and another $2,010 [Read More]

In an email letter to members of the Michigan State University Board of Trustees, the university’s new interim president, John Engler, reports he wants to fire Dr. William Strampel, Dean of the Osteopathic Medical School since 2002, for his role in the Larry Nassar case.

The President’s recommendation, after five days on the job, requires an affirmative vote of a faculty hearing committee to reverse his tenure.

Strampel has been on medical leave since last December.

According to an MSU news release, he was accused of not following-up on the medical procedures he asked Nassar to follow after a joint FBI and campus police department investigation into sexual abuse allegations concerning Nassar.

The release [Read More]

A former University of Michigan-affiliated pediatric rheumatologist who was investigated for having sex with a patient is facing federal child pornography charges, according to a federal complaint unsealed Feb. 12.

Mark Franklin Hoeltzel, 46, stood mute—meaning a not guilty plea was entered for him—in front of U.S. District Magistrate Judge Elizabeth A. Stafford. He is charged with receipt of and possession of child pornography. He faces up to 20 years in prison if convicted as charged.

U.S. Assistant Attorney General Mollie O’Rourke asked that Hoeltzel be immediately detained, which Stafford granted.

Defense attorney Raymond Cassar said he demanded the hearing to argue for his client’s release because he believes Hoeltzel, who had returned [Read More]

By SARAH HILLEGONDS
Recently, we have received reports that the Michigan Department of Health and Human Services (MDHHS) Office of Inspector General (OIG) is conducting aggressive audits of pharmacies that concentrate on invoice and inventory records. In most cases, the targets of these invoice and inventory audits are independent pharmacies. According to the OIG, the purpose of inventory audits is to ensure that a pharmacy is not billing Medicaid for more drugs than it purchased. But the methodology utilized by the OIG is susceptible to error, resulting in inaccurate overpayment demands, and there are questions as to the legality of these types of audits prior to July 1, 2015. This article [Read More]

By EWA MATUSZEWSKI
The upstreamists are coming! The upstreamists are coming! If you know what I’m talking about, I’ll consider you a loyal follower of this column—or someone who is already attuned to the social determinants of health (#SDOH). In my October 2017 column, I discussed a call to action on #SDOH and cited the upstreamist term used by Rishi Manchanda, MD, a physician and public health innovator who has worked in South Central Los Angeles and advocates for incorporating #SDOH into primary care.

I couldn’t be more excited to announce that Dr. Manchanda will be coming to Michigan (for the first time!) when MedNetOne joins with the Oakland University School of [Read More]