By LAUREN WEBER & SAM WHITEHEAD
As the country grapples with states’ newfound power to regulate abortion in the aftermath of this summer’s U.S. Supreme Court decision, state attorney general candidates are staking claims on what they’ll do to fight or defend access to abortion — and that’s attracting cash and votes.

“By pretty much every indicator there is in a campaign, the Dobbs decision has energized and supercharged our race,” said Kris Mayes, a Democrat running for attorney general in Arizona. “People are outraged about this, and you can feel it in the air.”

But they aren’t the only ones who may be testing the laws. The winners of local prosecutorial races will also shape the legal landscape, and, in many states, an attorney general’s ability to bring criminal abortion cases to court ends at a local prosecutor’s doorstep. Called district attorneys, prosecutors, and various other names across the country, these lawyers — not the attorneys general — would make the final decisions on whether criminal charges can be brought against people seeking abortion or the medical professionals that provide them.

The exceptions include states such as Delaware and Rhode Island, which have distinct attorney general and local prosecutorial structures, said David LaBahn, president and CEO of the Association of Prosecuting [Read More]

By EWA MATUSZEWSKI
I mentioned in a recent column that teaching is one of my passions, which is why I’m so grateful to have this column as an educational platform to share what’s new in Michigan’s healthcare community. It’s not just news though; rather, an opportunity to learn what your local community is doing to promote better health outcomes – and encourage you to get involved. To that end, I’m excited about an initiative launched earlier this month by the Michigan Department of Health and Human Services addressing the social determinants of health (#SDOH) in the COVID era.

With funding from the CDC and Center for State, Tribal, Local and Territorial Support grants, and based on the concept of regional health exchanges for data, the state has created 11 regional Health Equity Advisory Councils, run by Backbone organizations (BBO), from the following regions:

• Genesee County
• Ingham County
• Kent County
• Oakland County
• Ottawa County
• Macomb County
• Muskegon County
• Saginaw County
• Washtenaw County
• Wayne County

Working with BBO community organizations such as ACCESS, Detroit Association of Black Organizations (DABO), Metropolitan Organizing Strategy Enabling Strength (MOSES) and Judson Center, the Councils will focus on capturing and sharing health disparities data in the manner best suited to their community’s needs. This will [Read More]

By DUSTIN T. WACHLER
Following recent enforcement actions against a variety of telemedicine arrangements throughout the country, the U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG) published a Special Fraud Alert to notify practitioners to exercise caution when entering arrangements with purposed telemedicine companies.[1] The telehealth arrangements described in the OIG’s Alert implicate multiple federal laws including, but not limited to, the federal Anti-Kickback Statute, False Claims Act, criminal health care fraud statutes, as well as the OIG’s exclusion authorities related to kickbacks and Civil Monetary Penalties Laws provision for kickbacks. Additionally, such arrangements will also implicate state fraud and abuse laws related to kickbacks, fee-splitting, self-referral, false claims, and related issues.

The Special Fraud Alert explains that following dozens of investigations into telemedicine schemes, the OIG continues to target telehealth arrangements that may result in corruption of medical decision-making, harm to beneficiaries (including, for example, receiving medically unnecessary care, items that could harm the patient, or improperly delaying needed care), and increase in costs to the federal healthcare programs for medically unnecessary items and services. In several telehealth arrangements recently targeted by the OIG, telemedicine companies paid practitioners in exchange for ordering or prescribing items or services for purported [Read More]

By WASIF KHAN
For many healthcare providers, their roles as business owner and employer tend to be overshadowed by their role as a healer.   While employees can be your greatest asset, they also tend to be one of the largest liabilities as well.  Hiring the right employees – properly – will help mitigate risk and ensure compliance within the complex regulatory landscape of the healthcare industry.

How and What to Ask Pre-Offer

 Employers have historically asked prospective employees about their salary history before making an offer; however, many jurisdictions[1] have enacted laws that ban employers from doing so. Pre-employment, employers should focus on establishing compensation models commensurate with prevailing market rates and if necessary, inquiries should be focused on applicants’ salary expectations for the position they applied for.

Let’s be honest, salary tends to be a defining factor in hiring activity, but there are a number of questions that tend to be stumbling blocks earlier in the process. Employers must be certain that a prospective employee can actually perform the job that you are seeking to fill. In thinking about whether a prospective employee will meet your expectations, you may be tempted to inquire about limitations or disabilities, children/sick family members that are being cared for, or [Read More]

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

Nurses Sue U-M Over Refusal To Bargain

A lawsuit filed in mid-August alleges the University of Michigan is breaking the law by refusing to bargain over nurses’ workloads in contract negotiations with the University of Michigan Professional Nurse Council (UMPNC).

Michigan Nurses Association, the labor organization that filed the suit in the Court of Claims, says the 6,200 UMPNC nurses have worked without a contract since July 1. The organization alleges the university is violating the Public Employment Relations Act, which designates workload and safety as mandatory subjects of bargaining, and it wants an order compelling U-M to bargain.

The “major stumbling block,” MNA claims, is the administration’s refusal to discuss workloads in terms of number of patients assigned per nurse, which is tied directly to patient safety concerns that nurses have raised for months.

“When nurses are forced to take care of too many people at once, patient care gets compromised and nurses are put in danger of injury or burnout, and that’s happening far too often at our hospital,” said Renee Curtis, a registered nurse and president of UMPNC. “Our union is fighting for patient safety, first and foremost. It’s absurd to think [Read More]

This story appears courtesy of MIRS, a Lansing-based news and information service.

The Department of Health and Human Services (DHHS) budget for Fiscal Year (FY) 2023 passed early this morning includes funds to expand adult and child mental health services and programs, and opens the door to a restructuring of dental benefits in the state, among a cornucopia of historic funding.

Rep. Mary Whitford (R-Casco Twp.), chair of the House DHHS Appropriations Subcommittee, and Michigan Association of Health Plans Executive Director Dominick Pallone hailed the funding as a great investment into the health of Michiganders.

“MDHHS is thankful for improvements in access to affordable, high-quality dental services for Michiganders, raising rates for foster, adoptive, and guardian providers and investments in community organizations that provide direct support to families. Congrats to Gov. Gretchen Whitmer and the Legislature for passing a balanced, bi-partisan budget,” MDHHS spokesperson Lynn Sutfin said.

Whiteford highlighted the $325 million in funding going toward the creation of a new psychiatric hospital, $41 million to add 56 beds and 87 full-time positions to the Hawthorn Center, and $223 million in funding being directed toward several private sector mental health facilities, such as Pine Rest, U of M Medicine and McLaren Northern Michigan, to help expand access for [Read More]

This story appears courtesy of MIRS, a Lansing-based news and information service.

More than 60 Ascension Michigan health care workers filed a federal lawsuit seeking to recover wages lost when they were suspended for not getting mandatory COVID vaccines and not complying with the health system’s 2021 policy.

The proposed class-action suit, filed in U.S. District Court Western District, alleges violations of the Civil Rights Act of 1964 when hospital leaders placed employees on “involuntary, indefinite, unpaid leave of absence” in November 2021 after denying their religious exemptions requests.

According to the suit, Ascension required its employees – but not independent contractors, vendors, temporary staff, patients or visitors – to be vaccinated by 5 p.m. Nov. 12, 2021. Failure to do so would be “deemed voluntary resignation,” the suit claimed.

The plaintiffs submitted religious accommodation requests, but Ascension denied the requests while approving some based on “pure favoritism,” the suit alleges.

When the November deadline hit, the plaintiffs were placed on unpaid suspensions, but after five weeks, some slowly returned to work when hospital leaders faced “legal challenges” and “staffing challenges,” the suit claims.

The plaintiffs allege they were told the vaccine suspension had been recalled, but many employees denied religious accommodations were not recalled to work, which the suit [Read More]

By EWE MATUSZEWSKI
Anniversaries can be wonderful – or emotionally difficult. I just celebrated a milestone wedding anniversary – a joyous occasion. Yet, the first anniversary of my brother’s passing as a result of suicide is looming and brings back feelings of shock, disbelief and the lingering question, “Is there anything I could have done?” My brother and I were, sadly, neither geographically nor emotionally close as adults (his choice on both.) Yet the raw feelings remain, the helplessness, the abiding sense of loss.

In my head, I know there truly was nothing I could have done. But I choose to do something now. And that is to be open about death by suicide in this platform and any others I may have in order to spread a message of prevention; to advocate for mental health check-ups and encourage primary care physicians and Advanced Practice Providers to include mental health wellness checks in patient visits; and to share three easy digits that can save a life: 988.

988 was established to improve access to crisis services in a way that meets our country’s growing suicide and mental health-related crisis care needs. 988 will provide easier access to the Lifeline Network and related crisis resources, which are distinct from [Read More]

By JESSE ADAM MARKOS, ESQ.
Wachler & Associates

On June 27, 2022, three days after the U.S. Supreme Court overturned nearly 50 years of settled law in a direct assault on women’s rights and reproductive freedom, the Court issued an important decision for physician autonomy in a consolidated case ruling in Ruan v. United States. In that case, the Court raised the burden of proof for federal prosecutors seeking to hold physicians accountable under the Controlled Substances Act for the rise in addiction and death during the opioid crisis. While many of these prosecutions have certainly been laudable, others have involved treatment that was not so clearly egregious, treating what, at worst, could have been medical malpractice or standard of care violations, as criminal matters.

In each of the consolidated cases, the defendants were physicians licensed to prescribe controlled substances. Each was charged with violating 21 U.S.C. § 841, which makes it a federal crime to distribute or dispense controlled substances “except as authorized.” A federal regulation authorizes registered doctors to dispense controlled substances via prescription, but only if the prescription is “issued for a legitimate medical purpose by an individual practitioner acting in the usual course of his professional practice.” 21 CFR §1306.04(a).

At issue was the [Read More]

By KATHLEEN CAMPBELL WALKER
Dickinson Wright

On Feb. 12, 2022, the Subcommittee on Immigration and Citizenship of the House Committee on the Judiciary held a very informative hearing regarding the relevance of foreign physicians in the healthcare system of the United States. The hearing was titled, “Is There a Doctor in the House? The Role of Immigrant Physicians in the U.S. Healthcare System.” The testimony provided underscores the ridiculous labyrinth of immigration rules set to complicate and cause ongoing unpredictability for foreign physicians trying to obtain approval to serve the U.S. public – even when desperately needed.

Dr. David J. Skorton, the President and Chief Executive Office of the Association of American Medical Colleges (AAMC), which is a nonprofit comprised of members of all 155 accredited U.S. and 16 accredited Canadian medical schools, outlined the following critical points:

• Based on the AAMC’s review of American Medical Association (AMA) data in 2020 for physician practices, approximately 23% of active physicians practicing in the U.S. identified as foreign born. Many of whom are now U.S. citizens or legal permanent residents.
• AAMC projects that the overall physician shortage will grow to a total of between 37,800 to 124,000 physicians by 2034. This projection includes shortages of primary care physicians between [Read More]

Legislature Says Planned Parenthood’s Abortion-Ban Challenge ‘Premature’

Lansing Lines appears with cooperation from MIRS, a Lansing-based news and information service.

The Michigan Legislature asked a Court of Claims judge to dismiss Planned Parenthood’s lawsuit challenging the state’s abortion-ban law.

The filing says Planned Parenthood’s claims are “premature” because they “are based on a series of hypotheticals” and the relevant statute, MCL 750.14, “is not being enforced, and plaintiffs do not claim that there are any concrete threats of enforcement.”

“No state authority has sought to enforce the statute at issue here, making plaintiffs’ claims unripe,” the court brief from Nicholas Miller, of Washington, D.C.-based Schaeer-Jaffe LLP, reads on behalf of the Legislature. “First, Michigan’s statute cannot be used to prosecute pregnant women. … Second, there are … no pending prosecutions or threatened prosecutions of any abortion provider under MCL 750.14.”

The Legislature also argues Planned Parenthood lacks standing.

Some prosecutors have said they will prosecute the law if violated, which the Legislature argues is irrelevant to Planned Parenthood’s lawsuit, in part, because the prosecutors are not parties to the lawsuit.

The only prosecutor – and only defendant – on the case, Attorney General Dana Nessel, has repeatedly said she will not prosecute Michigan’s abortion-ban law.

Planned Parenthood filed its suit in April, [Read More]

A package of four Senate bills that modify the requirements for health facilities wishing to expand, including those increasing psychiatric bed numbers or purchasing an air ambulance, received a hearing in the House Health Policy Committee.

SB 181, sponsored by Sen. Curtis VanderWall (R-Ludington), would allow health facilities to bypass certificates of need in order to expand their number of psychiatric beds. It would also increase the threshold on expenditures requiring certificates of need to $10 million.

Currently, health facilities wishing to increase in size or spend more than $2.5 million on upgrades need a certificate.

SB 182, sponsored by Sen. Lana Theis (R-Brighton), would increase Certificate of Need Commission members from 11 to 13, and require one of the new additions to be from a county with 40,000 people or less.

Both bills are necessary to speed up outdated processes which hinder hospitals’ “ability to upgrade and expand efficiently,” said Jordan Jorritsma, VanderWall’s legislative director, in testimony before the House Health Policy committee.

“When we have places that want to expand current beds or build a new facility, I don’t believe we need this extra bureaucratic burden,” Jorritsma said, “which slows down the process of getting those beds online and operable.”

But trying to increase expansion could lead to more [Read More]

By SAM WHITEHEAD
Until last year, Georgia’s Medicaid coverage for new moms with low incomes lasted 60 days.

That meant the Medicaid benefits of many women expired before they could be referred to other medical providers for help with serious health problems, said Dr. Keila Brown, an OB-GYN in Atlanta. “If they needed other postpartum issues followed up, it was rather difficult to get them in within that finite period of time,” said Brown, who works at the Family Health Centers of Georgia, a group of community health centers.

Georgia lawmakers, recognizing the state’s high rate of pregnancy-related deaths, have taken action. In 2021, Georgia extended the Medicaid coverage window to six months postpartum. And, now, the state plans to broaden that benefits period to a year.

Georgia is one of a dozen states that have opted not to fully expand Medicaid — the federal-state health insurance program for people with low incomes or disabilities — under the Affordable Care Act. But nine of those states, mostly in the South, have sought or plan to seek an extension of postpartum Medicaid coverage, in many cases to a full year after a birth.

Some took advantage of a provision of the American Rescue Plan Act that allows states to extend coverage [Read More]

Maximize Your Learning Events With These Best Practices

By EWA MATUSZEWSKI
I will admit to being taken aback by how many positive comments I received on my last column: Don’t Get Trained – Learn! I appreciate all of the feedback and your interest. I hope I’m not wearing out my welcome by staying on this topic for June as well.

While it may be unusual for a healthcare executive to spend so much time in curricula development, it is a significant part of my work life. I attribute that not only to my love of learning but the sheer volume of new information coming out daily on health and well-being (and the billing codes to charge for them!) For better or for worse – but mainly for better, because it keeps things fresh and focused on patient care– those of us who work in health care administration or leadership are inundated with the latest news, trends, and research. But we can’t disseminate it all ourselves – or understand the nuances. We need to engage with colleagues, experts and authorities from respected organizations to gain additional perspectives and digest what it all means.

To that end, I think it helps to keep in mind some best practices prior to organizing [Read More]

What Is In A Diagnosis Code? More than you might Think for Medicare Advantage Payments

By ROLF LOWE
The International Classification of Diseases (ICD) used by both providers and payers to identify diagnoses and procedures was developed by the World Health Organization and has been in place since the mid 1970’s. The utilization of ICD codes for various aspects of delivering healthcare services has increased since their introduction and is now an integrated part of many payment and reimbursement models. The Centers for Medicare & Medicaid Services (CMS) collects information on the ICD codes as a condition of payment, including it as an area of information to provide on the CMS 1500 forms providers use for reimbursement. CMS also relies on the ICD codes for the payments it makes to Medicare Advantage Plans (MA plans). The ICD codes are part of a system used by CMS based on actuarial evidence to structure the payments it makes to MA Plans for their enrolled beneficiaries in a capitated payment model.

The principle of “actuarial equivalence” originates in how CMS is required to calculate payments to MA plans. Unlike traditional Medicare or fee-for-service payment models, MA plans are paid a monthly capitated per-beneficiary fee by CMS to cover the cost [Read More]

LANSING LINES

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

House Education Focus On COVID-19 Policy Is ‘Waste Of Time,’ Dems Say

More bills limiting mask mandates and vaccines in schools are “wasting time” on issues that won’t help students, Rep. Darrin Camilleri (D-Brownstown Twp.) said after the House Education committee voted out a package on COVID-19 policy in schools.

SBs 600-603 would prohibit mandatory vaccinations, face masks or testing for students to attend school or school events.

The bills were all reported with recommendation from the committee on a 7-5 vote.

But Camilleri, who voted no, said moving forward with the legislation is a waste of time when no Michigan schools require mask mandates.

“I think it was another day where we were wasting time on culturally divisive issues that will not improve the outcomes for our students in our public schools,” Camilleri said.

Instead, he said the committee should focus on more pressing issues, like the teacher shortage or student learning loss.

“Why are we talking about mask mandates and vaccines?” he asked.

Camilleri said House Democrats have introduced many bill packages addressing teacher shortages and expanding school libraries, among other things, but many of them are yet to get a hearing.

“I will always remain hopeful [Read More]

House Insurance Committee Chair Daire Rendon (R-Lake City) began the process of passing legislation that penalizes auto insurers that are not fully compensating the providers of those taking care of people catastrophically injured in car accidents.

Although it wasn’t on the agenda, Rendon took up Rep. Ryan Berman’s (R-Commerce Twp.) HB 5870, which hits insurers acting in bad faith that don’t pay the bill sent to them by providers three times the amount of the overdue payment plus attorney costs.

She then took testimony from health care providers who claimed they hadn’t been compensated under the law for, in some cases, 10 months. They claimed they are having to take money out of their own pockets to make payroll.

The sudden change in the agenda caught fellow members and House leadership by surprise. It spurred several members, including Vice Chair Beau LaFave (R-Iron Mountain) and Republican Caucus Chair Matt Hall (R-Comstock Twp.) to walk out of committee. Berman’s bill didn’t move, but Rendon said she is interested in reporting it out in the future.

The Speaker’s office wasn’t aware the subject was being taken up, even though Speaker Jason Wentworth (R-Farwell) had said previously he’s not interested in taking up any major reforms to the state’s auto insurance this [Read More]

By MICHELLE ANDREWS
Andrew Bade, who was diagnosed with Type 1 diabetes nearly two decades ago, is accustomed to all the medical gear he needs to keep his blood sugar under control. His insulin pump contains a disposable insulin cartridge, and a plastic tubing system with an adhesive patch keeps in place the cannula that delivers insulin under his skin. He wears a continuous glucose monitor on his arm.

Bade, 24, has used the same equipment for years, but every three months when he needs new supplies, his health insurance plan requires him to go through an approval process called prior authorization.

Getting that approval can take as many as three weeks, and Bade sometimes runs out of insulin before it comes through. When that happens, the resident of Fenton, Michigan, makes do with leftover preloaded insulin pens. They’re less precise than the pump, and he feels tired when he uses them. But they get him through.

“I don’t understand why they’re taking all this time to make these decisions and then they always say ‘yes’ anyway,” Bade said.

Michigan legislators in April sought to help patients like Bade by approving a law that sets standards meant to hasten that process. Beginning in June 2023, health plans will have to [Read More]

By EWA MATUSZEWSKI
While I may occasionally substitute the word training for learning, my strong preference when bringing professionals together to gain new insights is to focus on the learning that is taking place. Training too often connotes the visual of people gathered in a classroom being told from an “expert” how to tackle a particular issue or topic, while learning takes on a more comprehensive approach and includes sharing experiences among those assembled.

I broach this matter today because late last month, our organization sponsored a conference on Health Information Exchange (HIE) presented by Practice Transformation Institute and supported through a grant from BCBSM. A mainly in-person event, I attended virtually from New Hampshire where I was awaiting the birth of my first grandchild. (Yes, I can vouch for how wonderful grandparenting is, even from a distance!)

The conference objective was for participants to learn how the sharing of clinical and administrative data across the healthcare system contributes to improving patient safety, overall quality of care, public health and healthcare. Some topics included:
• Transforming care with connected teams
• What’s love got to do with HIT – how health information technology and the exchange of information between patients and providers is good for all
• Impacting the delivery of [Read More]

By STEPHEN SHAVER
Wachler & Associates, PC

The week of May 9, healthcare providers began to find out if their requests to file late reports under the Provider Relief Fund were granted. Providers whose requests were granted will have 10 days to file the required reports, while providers whose requests were denied can likely expect a repayment demand. These decisions are the latest chapter in the saga of the ever-shifting reporting requirements under the PRF.

Although initially intended to keep the nation’s healthcare providers afloat during the early days of the COVID-19 pandemic, the PRF has since descended into a bureaucratic labyrinth of compliance traps ready to snare the unsuspecting provider. The PRF is a $178 billion fund created by Congress through the CARES Act and currently administered by the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services. HHS has subdivided the PRF into various general and targeted distributions. These distributions were paid to providers in several waves between April 2020 and the present. Although there are currently dozens of types of distributions under the PRF, the highest value and most widely distributed payments were paid out to providers as general distributions in Spring and Summer 2020. These early payments included [Read More]

By RALPH Z. LEVY JR.
A prior article in this publication (IRS Attack on Zeroed Out Taxable Income in Recent Tax Court Cases) discussed the lessons that physician and other incorporated medical practice groups could learn from taxpayer losses in two then recent Tax Court cases in use of the “zero out” technique in the payment of compensation to the group’s owners. Under this approach, the practice group typically compensates its physician-owners or other licensed professional shareholders by payment of a portion of the anticipated pre-tax operating profits as compensation (salary) in regular increments during the tax year and then it will distribute the bulk of its profits in bonuses that are paid at year-end. For practice groups organized as ‘C’ corporations, the salary and year-end bonuses are deducted as compensation. As a result, the practice entity will pay little or no federal income taxes. The potential tax risk to this compensation method is that, depending on the facts and circumstances of each situation, the Internal Revenue Service (IRS) could disallow the compensation deduction for the “salary” and bonuses paid and treat these payments as non-deductible dividends made by the practice entity to its shareholders.

Two recent cases provide additional insight into how the zero out [Read More]

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

40% Of Health Clinics Saying No To Opioids

Doctors in Michigan are writing fewer opioid prescriptions, but the state’s death rate continues to climb. Also, more than 40% of the health care clinics have a sign on their doors: We do not prescribe opioids.

Those are two of the major takeaways from a three-hour presentation at the Spring Scientific Convention sponsored by the Michigan Osteopathic Association earlier this month.

A trio of physicians told the members that many doctors are “afraid” of being prosecuted by the state for alleged overuse of the addictive painkillers. To avoid any such action, they just stopped writing those scripts.

On any given day, 20% of the state’s adult population is experiencing chronic pain and the death rate from these overdoses has risen just over 9% last year and 170% in the last six years.

Dr. David Neff, who has been on the front line of the opioid crisis for years, reports a patient faces possible addiction after only seven to 10 days of taking the drug. For those who are addicted and are able to break the habit, he reported it can take up to four years for the human [Read More]