Ahead of national physician assistant (PA) week, Oct. 6-12, several House members introduced a bipartisan, four-bill package including PA’s under the blanket of mental health professionals and changing their title to “physician associate.”

The bills, sponsored by Reps. Carrie A. Rheingans (D-Ann Arbor), Donavan McKinney (D-Detroit), Reggie Miller (D-Belleville) and Curtis VanderWall (R-Ludington), create the “Patient-Led Care Bill Package,” which Rheingans said will improve patient access to care, “while also reducing some of the red tape that’s standing in the way of physician assistants.”

Rheingans’ bill, which she said was read in this afternoon, would address the 3.5 million Michiganders living in a health provider shortage area, including the 38% of Michiganders who experience a mental illness and have an unmet treatment need.

“Since we know patients deserve the highest quality of care from professionals who are trained to provide it, we’re here trying to address this gap,” she said. “Sometimes, outdated laws on the books get in the way of people’s ability to provide that care.”

Her bill would amend the mental health code to include PAs and nurse practitioners under the definition of mental health professionals, allowing an additional 7,400 practicing PAs to treat patients with mental health concerns, Rheingans said.

She said approximately one in five of them are in primary care [Read More]

By SUSAN ADELMAN, MD
The British have a one-payor public healthcare system, the National Health Service (NHS), which pays for most medical care in the UK. For the rest, many NHS doctors also see patients privately, and a number of others have strictly private practices. As our English cousins explained, the NHS has been breaking down and running short of money for years. Now, the aftermath of COVID and the onset of serious inflation have stimulated widespread strikes. And for the first time, both junior doctors and consultants are walking out together nation-wide for three to four days at a time. The issues are both financial and matters of patient care. Doctors complain of being forced to work long hours without a break, and junior doctors have suffered a pay cut of 26.1% since 2008.

The British Medical Association (BMA) represents 75,000 doctors. It has requested raises of 12% for consultants and 35% for juniors, just to match real salaries paid in 2008. Last year junior doctors were offered a 2% increase. More recently, the government offered raises of 6% to 8.8%. They say it is their last offer. So far, negotiations with both consultants and junior doctors have been stalled since May, and the BMA announced [Read More]

By EWA MATUSZEWSKI
When you hear the name, Salvation Army, you think Red Kettle, right? As you should; but don’t just think about bell ringing at the holidays. Salvation Army, a faith-based, nonprofit organization dedicated to serving people in need without discrimination, can be an excellent partner to physician organizations and other healthcare groups seeking sustainable change in the community through grass roots efforts.

While I’ve been on the Metro Detroit Advisory Board of the of the Salvation Army since 2021, I was not asked to write about the organization. I just can’t help myself. Our working relationship started in 2020, when MedNetOne Health Solutions collaborated with the Salvation Army to bring primary care services to its Macomb Harbor Light facility, a residential treatment program for those experiencing substance use disorder, and one of three operated by the Great Lakes Division.

Like many positive working partnerships, our collaboration grew – in large part due to the leadership of Capt. Jamie Winkler, executive director of the Eastern Michigan Harbor Light System. Most recently, Capt. Winkler decided to spearhead the Salvation Army’s efforts with the Michigan Medicaid redetermination program, which is part of a post-pandemic nationwide initiative to assist Medicaid beneficiaries verify the factors of eligibility to ensure continuation of [Read More]

By JENNIFER COLAGIOVANNI
Wachler & Associates, PC

In August 2023, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) announced its strategic plan for managed care oversight.  OIG’s plan involves rigorous oversight of managed care plans while also closely coordinating with the plans in the efforts to fight fraud, waste, and abuse. OIG’s plan will scrutinize Medicare and Medicaid managed care contracts from inception through enrollment, reimbursement, services, and renewal. In order to address fraud, waste, and abuse risks, the goal of OIG’s plan is to hold Medicare Advantage organizations (MAOs) and Medicaid managed care organizations (MCOs) accountable.

Currently, more than half of Medicare enrollees and more than 80% of Medicaid enrollees are covered by managed care programs. In order to oversee the almost $700 billion that the federal government spent on managed care programs in 2022, OIG has set out four stages of the managed care life cycle that it intends to investigate: (1) plan establishment and contracting, (2) enrollment, (3) payment, and (4) provision of services.

Plan Establishment and Contracting: OIG intends to review activities that occur when the Centers for Medicare & Medicaid Services (CMS) or states initially establish or renew managed care contracts. In this contract review phase, [Read More]

By ALLISON TUOHY & MARK E. WILSON
In an age of highly polarized opinions, there is a common consensus to address the rapidly rising health care costs in the United States. Research shows that the US average gross national product for health care costs is 17.1% while the rest of the world average is about 10.6%; the US missing that mark costs $1.7 trillion per year. There are numerous opinions and beliefs on how to achieve significant savings in health care without sacrificing quality of care.

Many believe that the current “fee-for-service” model simply incentivizes the health care system to treat “sick” patient symptoms rather than to practice preventative care. Attempts to control costs by reducing individual fee-for-service rates have not been successful. Over the past ten years, new concepts like ACOs, CINs and other similar operational vehicles initiated the shift from fee-for-service financing. The ultimate goal has been to move toward a true risk-and-reward model that incentivizes health care practitioners to delay or reduce unfavorable medical outcomes as long as possible.

Value-based care is a health care delivery model that aims to proactively adjust the quality and timing of patient care thus reducing overall costs. The model rewards providers based on influencing positive patient outcomes [Read More]

When I started out as a reporter, I got to know the major players in healthcare in Michigan. Most came from Metro Detroit or Lansing. A few came from West Michigan. But there was this one guy who worked for a county medical society in the middle of the state who seemed to be involved in all of the major health policy debates and a bunch of obscure ones.

He was a bear of a man, tall and broad in stature with a booming voice and loud laugh that had the playful ring of childhood on the edges. He brought passion and caring to every issue on his docket. And he was smart, no, more than that, he was wise.

Under his stewardship, the Genesee County Medical Society left a large footprint disproportionate to its size. Pete seemed to convince his members and the state medical society that GCMS doctors belonged in leadership positions. Once there, they advocated strongly for traditional physician interests such as reimbursement issues medical liability policy, but also environmental issues and single-payer universal healthcare.

After I made the move to Lansing to work for the state legislature on health policy, Pete and I kept in touch, his insightful perspectives and wry sense of humor [Read More]

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

Immigrant Children, Pregnant Women Wouldn’t Need To Wait For Medicaid Under Bill

The five-year waiting period for immigrant children and pregnant women to be able to use Medicaid services in Michigan would be waived under a bill taken up by a House committee early this month.

Rep. Alabas A. Farhat (D-Dearborn) told the House Insurance and Financial Services Committee that HB 4740 would help the lives of immigrants while addressing infant mortality and children’s health issues.

“It’s transformational for some lives and helps ensure that there are safe patches for that child,” Farhat said.

Sara Ismail of the Arab Community Center for Economic and Social Services (ACCESS) told a story about a family that had been living in the United States for nearly four years, but couldn’t get insurance.  She said they had to rely on free clinics and limit their visits to the emergency room.

Michigan Council for Maternal and Child Health Executive Director Amy Zaagman told a similar story and said many of those populations didn’t get the health care they needed because of it.

“They increase utilization of higher intensity services, like emergency rooms. They struggle to find providers that will even accept them. They miss out on critical preventative services, [Read More]

Six bills rolling back 30 years of abortion restrictions put on the books by Republican majorities moved through a House committee this morning, but their future in the full chamber is dubious after one Democrat came out against them and more may be on the way.

Rep. Karen Whitsett (D-Detroit) issued a press release two minutes before today’s House Health Policy Committee that she would not support the 11-bill Reproductive Health Act, which includes legalization of late-term elective abortions.

One piece of the package allows taxpayer money to fund elective abortions, which Whitsett said she could not support at a time when many seniors in her district live in poverty.

“Elderly citizens across our state are forced to make unthinkable trade-offs just to survive – deciding between food, shelter or the medication that literally keep them alive,” she said. “We have an unbreakable moral obligation to direct limited Medicaid resources first and foremost toward caring for these vulnerable grandparents who built the very fabric of our society.”

MIRS has learned Whitsett is not the only Democrat with concerns. Democrats representing strong communities of faith are fine returning Michigan to a Roe v. Wade environment, but they are not OK with dismantling the guardrails around the procedure.

Five of the 11 bills – two allowing for Medicaid-paid abortions [Read More]

By EWA MATUSZEWSKI

I’ve been hesitant to dip my toe into the artificial intelligence (AI) discussion in this forum because so much has been written about it in a short period of time. What can I add at this early juncture? I changed my mind after a healthcare tech colleague recently asked me to test out a platform using AI that helps clinicians access evidence-based guidelines or even determine if a patient needs to have a consult with a specialist. While I’m not a clinician, it’s not unusual for me to test products and services that may help our healthcare provider members in their quest to provide high quality care. Following and responding to the designated steps, the ‘Need a Consult?’ option popped up. Sure, I’ll bite! I clicked on the option and – lo and behold – a real-life specialist appeared on the screen! Wow – this could really be a neat tool. AI can be wonderful! And yet…

I couldn’t help but recall when the Michigan Quality Improvement Consortium (MQIC) offered simple guidelines to primary care physicians on topics like diabetes, pediatric obesity, hypertension, co-morbidities, and behavioral health. Updated every two years by healthcare professionals the guidelines had a Michigan-focused context and were an extremely [Read More]

By SUSAN ADELMAN, MD
As most might guess, marijuana is the commonest illegal drug in the United States. An estimated 48.2 million people used it at least once in 2019. The percentage of U.S. drivers with marijuana detected in their blood was 8.6% in 2007 and rose to 12.6% in 2013-14. Should marijuana be legalized nationally? For safety’s sake, are there legal blood limits for drivers?

Marijuana and hemp come from the Cannabis sativa plant.  Legally, hemp is defined as any part of the cannabis sativa plant that contains 0.3 percent or less of THC (tetrahydrocannabinol), while marijuana contains more than 0.3 percent THC. THC is the substance that causes a high. CBD (cannabidiol) does not. In some sources, cannabis is a Schedule 1 drug, as is heroin, but the Michigan Public Health Code says “Marihuana, including pharmaceutical-grade cannabis, is a schedule 2 controlled substance if it is manufactured, obtained, stored, dispensed, possessed, grown, or disposed of in compliance with this act and as authorized by federal authority.”

In 2018, the U.S. Congress passed the Agriculture Improvement Act, removing hemp from the federal Controlled Substances Act and effectively legalizing CBD if it comes from hemp. Confusingly, marijuana still may be illegal at the federal level, but 24 [Read More]

By DANIEL AYYASH

Overview

At its core, hospice provides palliative care and support for terminally ill individuals and their families. People who elect to receive hospice care generally receive this care in the home setting by a team of professionals and caregivers who are specially trained to address the sensitive needs of those nearing end of life. In addition to meeting patients’ physical needs, hospices provide care for the “whole person,” which includes care that meets their emotional, social, and spiritual needs. Being able to provide beneficial, high-quality care is critical to the successful efforts of hospice providers. Recently, the Centers for Medicare & Medicaid Services (CMS) indicated that they have noticed an increasing trend of hospice services fraud. In response to this perception, CMS is significantly increasing its attention and scrutiny on hospice providers.

CMS Observations

In recent statements, CMS claims to have identified instances of hospices certifying patients for hospice care when they were not actually terminally ill, as well as providing minimal or no services to patients. CMS also claims that some of the addresses listed for these allegedly fraudulent hospices appear to be tied to non-operational locations. Additionally, CMS highlighted a particular trend known as a “churn and burn” scheme, where a new hospice opens [Read More]

By RALPH Z. LEVY & CYNTHIA A. MOORE

Adverse tax issues can arise for physicians and other professional practice groups interested in issuing equity to attract and retain junior physicians.  If equity is issued at below fair market value, the new equity owner will incur significant federal income tax consequences on issuance.  If the new practice entity owner leaves the practice, the practice entity could experience difficulty in funding the amount needed to repurchase the equity from the departing professional.  These adverse tax and other consequences at buy-in and buy-out can be avoided by proper planning and a well-designed buy-sell agreement.

 Issues for the New Practice Owner

Federal tax law taxes income of all types, whether cash, property, or other forms.  For employees of a practice entity, if an employee is issued equity in a practice and does not pay for the equity at its fair market value, the employee must include in income for federal tax purposes the “bargain element” of the equity received.  This applies regardless of the form of the equity – be it stock in a professional corporation (PC), a membership interest in a professional limited liability company (PLLC), or a partnership interest in a professional limited liability partnership (PLLP).

 Issues for the Practice Entity

Even [Read More]

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

Universal Lead Testing Bills For Children Heading To Gov’s Desk

Young children must be tested for lead poisoning, with records of their testing placed on the same immunization certificate used to document childhood vaccines, under legislation currently on its way to the Governor’s desk.

“What this legislation does is it requires universal testing for minors for lead, and really what this is about is making sure that we are giving protection to kids from a variety of potential vectors of exposure to lead,” Sen. John Cherry (D-Flint) said to members of the media today, speaking about HB 4200 and his own SB 31 , which are tie-barred.

Cherry’s SB 31 deals specifically with the new testing instruction itself, mandating a physician to have a child tested for lead – or to order a test for them – once at 1-years-old, once at 2-years-old and once at 4-years-old if the minor resides in a geographic area flagged by the state’s health department for posing an elevated risk for childhood lead poisoning.

Additionally, if the child has not been tested earlier in life, they may be tested for lead poisoning at least once between 2- and 6-years-old.

HB 4200 by Rep. Helena Scott (D-Detroit) deals with the written certification [Read More]

By HARRIS MEYER
As regulators review Kaiser Permanente’s proposed acquisition of a respected health system based in Pennsylvania, health care experts are still puzzling over how the surprise deal, announced in April, could fulfill the managed care giant’s promise of improving care and reducing costs for patients, including in its home state of California.

KP said it would acquire Danville, Pennsylvania-based Geisinger — which has 10 hospitals, 1,700 employed physicians, and a 600,000-member health plan in three states — as the first step in the creation of a new national health care organization called Risant Health. Oakland-based Kaiser Permanente said it expects to invest $5 billion in Risant over the next five years, and to add as many as six more nonprofit health systems during that period.

Industry experts believe KP’s aim is to build a big enough presence across the country to effectively compete with players like Amazon, Aetna CVS Health, Walmart Health, and UnitedHealth Group in providing health care for large corporate customers. Kaiser Permanente executives touted the potential for spreading the group’s vaunted brand of quality, lower-cost care around the country.

But it’s not clear how KP will be able to bring its model, in which facilities and doctors receive a monthly per-member fee for all care, [Read More]

By SUSAN ADELMAN, MD
I am a pediatric surgeon. I have operated on babies who were born without a functional anal orifice, but I have never operated on babies who were born with what were called ambiguous genitalia. It just never came up in my practice. These were specialized procedures done by surgeons with advanced training and experience in such delicate matters.

With that caveat, let me weigh in on the subject of surgery designed to transition a child from his or her biological gender to the opposite gender. When I was in practice, a request for this type of surgery primarily came up in the case of babies with ambiguous genitalia that did not fit their genotype properly, usually because of hormonal abnormalities. This was more than 50 years ago, when most young surgeons were taught that, in the case of feminized or partially feminized genitalia, since it was impossible to create a functioning penis, it was more prudent to remodel the perineum by creating clearly feminine looking external genitalia. So that is what they did. Sadly, some of these children were actually biologic males and later felt themselves to be male as they grew up—a potential psychologic, anatomic and physiologic tragedy. It must be pointed [Read More]

By EWA MATUSZEWSKI
We’re a smart bunch in healthcare. We are always innovating, elevating and evolving with a tech-centric mindset. But in our quest to achieve quality scores of 3.0, 4.0 or the coveted 5.0, have we forgotten some of the basics so critical to quality, patient-centric care?  The recent hospital stay of a family member fraught with missteps and a mind-boggling lack of communication and human connection, has me thinking of a decidedly old-fashioned tool that needs to be re-emphasized in the health care context: the satisfaction survey.

In modern terms, it’s actually the user experience survey, but for our purposes it’s the patient experience of care survey. I can hear your response already. “We already have patient review options on Google and Yelp! And then there are physician reviews through CAHPS.” Of course, online review portals abound, but for purposes of overhauling the patient’s experience of care, there needs to be dialogue rather than a complaint or love letter forum.

I wonder if our adherence to national regulatory organizations like CQA, URAC and The Joint Commission – all important to quality care – have allowed us to be sidetracked from also appropriately measuring the patient care experience. The auto industry has multiple regulatory agencies, but their [Read More]

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

Overview

On Aug. 1 the Centers for Medicare and Medicaid Services (CMS) issued a final rule establishing the Medicare hospital inpatient prospective payment system (IPPS) rates and long-term care hospital prospective payment system (LTCH PPS) rates for the 2024 fiscal year (FY). CMS is required to publish annual payment rates by law, which are based on factors such as diagnosis, patient condition, treatment provided, and the local cost of labor. Inpatient hospitals who participate in the Hospital Inpatient Quality Reporting (IQR) program and show adequate utilization of an electronic health record (EHR) will see a payment increase of 3.1%. Long-term care hospitals will see an increase of 3.3% in the standard payment rate but actual payments for discharges will only increase by approximately 0.2%. The rule is slated to be published in the Federal Register on August 28 and will take effect October 1, 2023.

The Hospital Inpatient Prospective Payment System (IPPS)
The IPPS, establishes prospective rates of payment for Medicare Part A beneficiaries requiring acute care hospital inpatient stays. Each stay is categorized into a Medicare Severity Diagnosis-Related Group (MS-DRG), which then has a payment weight assigned to it. MS-DRGs are based on factors such as the patient’s diagnosis, [Read More]

By ALLISON TUOHY
Dickinson Wright

Hospitals play a vital role in ensuring the well-being of communities by recruiting and employing skilled physicians. However, physician recruitment in compliance with the Stark Law can be a complex task for hospital administrators, especially as hospitals and medical practices face an average 7.6% annual physician turnover rate.[1]

The Stark Law, which was enacted to prevent potential conflicts of interest and ensure the integrity of physician referrals, prohibits physicians from referring patients for designated health services to entities in which they have a financial interest unless an exception applies. At face value, physician recruitment arrangements present potential Stark Law violations if hospitals expect referrals from physicians or hope to gain financial benefits from relationships with the physicians.

An important Stark Law exception is the physician recruitment exception, which applies to hospitals, federally qualified health centers, rural health clinics/hospitals, and physicians joining established medical groups.[2] The recruitment exception allows for a hospital to pay a physician to relocate to the geographic area served by the hospital and join the hospital’s medical staff.[3] This geographic area served is the area composed of the lowest number of contiguous zip codes from which the hospital draws at least 75% of its inpatients. [Read More]

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

Cannabis Sales Set Record In July As Price Rebounds

Cannabis sales hit a record high in July, according to Cannabis Regulatory Agency (CRA) data, which also found prices for marijuana-related products on the rise after hitting an all-time low in January.

Total sales in July set a state record with nearly $271 million. Prices are still down year-over-year, but the CRA data showed the average per-ounce price of flower, known as bud, has increased steadily since the industry low of $80 in January to nearly $99 in July. The amount being sold and held in inventory also grew over six months.

“I don’t know that you can point to any one specific thing, to be honest, but I mean I think it’s a multitude of consumer attitudes, more municipalities coming online, the enforcement issues, and we’ve been doing this since 2017,” said PharmaCann Government Regulatory Affairs Officer Shelly Edgerton.

Edgerton, former president of the dissolved Michigan Cannabis Manufacturers Association, said the market seems to be maturing. She said manufacturers had become more efficient in their production methods and distributors had learned how much product they needed to maintain freshness on their shelves.

Overall, January saw 341,587 pounds [Read More]

By CHERYL PLATZMAN WEINSTOCK

If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing “988,” or the Crisis Text Line by texting “HOME” to 741741.

Aimee Quicke has made repeated trips to emergency rooms, hospitals, behavioral health facilities, and psychiatric lockdowns for mental health crises — including suicidal thoughts — since she was 11.

The 40-year-old resident of Le Mars, Iowa, has bipolar and obsessive-compulsive disorders. “Some of the visits were helpful and some were not,” she said. “It was like coming in and going out and just nothing different was happening.”

Then she heard about Rhonda’s House, a rural peer respite program that opened on the other side of the state in 2018, through acquaintances in her community.

That facility, and dozens of others like it established nationwide over the past 20 years, offers a short-term, homelike, nurturing environment for people who are experiencing a mental health crisis but don’t need immediate medical attention. At respites, patients are treated like guests, proponents say, and can feel heard and keep their dignity without having to relinquish their clothes and other belongings.

During her weeklong stay at Rhonda’s House, which founder and executive director Todd Noack referred to as “a bed-and-breakfast [Read More]

By BRAM SABLE-SMITH, DANIEL CHANG, JAZMIN OROZCO RODRIGUEZ & SANDY WEST

Hal Dempsey wanted to “escape Missouri.” Arlo Dennis is “fleeing Florida.” The Tillison family “can’t stay in Texas.”

They are part of a new migration of Americans who are uprooting their lives in response to a raft of legislation across the country restricting health care for transgender people.

Missouri, Florida, and Texas are among at least 20 states that have limited components of gender-affirming health care for trans youth. Those three states are also among the states that prevent Medicaid — the public health insurance for people with low incomes — from paying for key aspects of such care for patients of all ages.

More than a quarter of trans adults surveyed by KFF and The Washington Post late last year said they had moved to a different neighborhood, city, or state to find more acceptance. Now, new restrictions on health care and the possibility of more in the future provide additional motivation.

Many are heading to places that are passing laws to support care for trans people, making those states appealing sanctuaries. California, for example, passed a law last fall to protect those receiving or providing gender-affirming care from prosecution. And now, California providers are getting more calls from people seeking to relocate [Read More]

By EWA MATUSZEWSKI
‘Dr. Smith’, a specialty physician, retired during the pandemic. His office lease was up and the thought of committing to another five-year lease amid ongoing uncertainty seemed unwise. Did he move onto a life of golf, travel, and other leisure focused activities? Hardly. He didn’t move on at all. As a matter of fact, he was bored silly. It was an opportunity to switch fields and take on a new position at a local hospital that crystallized his thinking on retirement. Namely, he didn’t want to be retired – at least not yet.

I have plenty of other anecdotal stories of physicians who retired too soon. What I’m beginning to believe is that we can find a role for these retired-too-soon physicians. Admittedly, many do not want to return to their previous physician lives. The stress of running a private practice and its myriad details and push and pulls – especially the hiring and retention of staff and the many business details and uncertainties of self-employment – has permanently lost its appeal. And for those who were hospital-employed, the internal politics of health systems, a perceived lack of autonomy and the constant push to use more hospital services, keeps them from returning.

A consistent message [Read More]

By JENNIFER COLAGIOVANNI, ESQ
Wachler & Associates, P.C.
The pandemic changed the relationship between patients and their healthcare providers, and telehealth use surged during the COVID-19 pandemic. Specifically, Medicare beneficiaries used telehealth services 88 times more often during the first year of the pandemic than in the year prior.  Medicaid and private health plans saw similar growth in the use of telehealth.  With this growth came concerns about the risks of fraud, waste, and abuse. The Office of Inspector General (OIG) for the Department of Health and Human Services (HHS) recently released a toolkit setting forth methods to analyze telehealth claims and identify risks associated with telehealth services in the wake of the COVID-19 pandemic.

The toolkit is designed to assist public and private plans with oversight efforts and additional safeguards. The OIG toolkit provides an approach for analyzing claims data to identify potential areas of program integrity risk associated with telehealth, including seven program integrity measures that may further indicate fraud, waste, and abuse.  Developed based on analysis of both Medicare fee-for-service and Medicare Advantage claims, the seven measures focus on different billing practices that may indicate efforts to inappropriately maximize telehealth payments.  And while the toolkit is written as guidance to public and private stakeholders, these [Read More]

By ANDREW SPARKS
Dickinson Wright
A recent decision by the Supreme Court clarified the required intent for a defendant to be held liable under the False Claims Act.  According to the Court, the FCA’s scienter requirement refers to a defendant’s knowledge and subjective beliefs – not what an objectively reasonable person might have known or believed.  This ruling removes potential defenses for FCA defendants and makes the dismissal of FCA claims on the basis of scienter much less likely before discovery has been completed.

Background

The consolidated cases involved allegations that two pharmacies defrauded Medicare and Medicaid by selling drugs at a lower rate to the public, while receiving reimbursement at a higher rate from the government.  See United States et al. ex rel. Schutte et al. v. Supervalu Inc., et al, No. 21-1326, and United States et al. ex rel. Proctor v. Safeway, Inc.,, No. 22-111.

A brief explanation of the payment system is helpful to understanding this ruling. State Medicaid plans offer outpatient prescription drug coverage to qualifying people.  However, the Center for Medicare and Medicaid Services has issued regulations that limit pharmacies’ reimbursement rates to the lower of either the (1) actual acquisition cost plus a dispensing fee or (2) the provider’s usual and customary [Read More]

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

Appellate Court Affirms Dismissal Of Suit Challenging MSU Vaccine Mandate

A federal appellate court affirmed this month the dismissal of a lawsuit challenging Michigan State University’s COVID-19 vaccine mandate.

In a published opinion from Circuit Judge John K. Bush, the court held that MSU’s policy “furthers a legitimate government interest of protecting public health.”

Bush added: “Thus, the policy passes rational basis review. Given that MSU’s policy satisfies rational basis review, no employee’s rights are violated, and thus the policy is not an unconstitutional condition on plaintiffs’ employment.”

The panel, including Judges Raymond M. Kethledge and Helene N. White, also rejected the plaintiffs’ argument that MSU’s policy is preempted by federal law regulating the distribution and use of pharmaceuticals.

MSU announced in July 2021 a directive that all faculty and staff had to be fully vaccinated or receive at least one of a two-dose series of vaccines by Aug. 31, 2021, including employees who worked remotely.

The policy provided for religious and medical exemptions.

The plaintiffs – Jenna Norris, Kraig Ehm and D’ann Rohrer – each tested positive for COVID-19, and they claimed their naturally acquired immunity should exempt them from the policy, but the university disagreed.

While Norris was eventually granted a religious exemption, Ehm’s employment was [Read More]