The Daily Scan

September 24, 2018

Last Updated: 1:00 PM EST

Litigation

  • Judge Amy Berman Jackson of the U.S. District Court for the District of Columbia dismissed the matter of ACLA v. Azar on Friday due to lack of subject matter jurisdiction. The plaintiff's motion for summary judgment was denied, and the defendant's motion for summary judgement on the merits was denied as moot. Plaintiff American Clinical Laboratory Association (ACLA), a trade association that represents clinical and anatomic pathology laboratories, had challenged a regulation issued by the Secretary of the U.S. Department of Health and Human Services, Alex M. Azar, II. The regulation at issue implemented Section 216 of the Protecting Access to Medicare Act of 2014 (“PAMA”) by requiring certain laboratories to report pricing information to the agency for use in establishing Medicare rates. ACLA contended that the definition of the term “applicable laboratory” in the regulation violated PAMA and the Administrative Procedure Act (“APA”). In response, Azar asserted that in the statute, Congress expressly precluded judicial review of issues such as these, and the Court had no jurisdiction to hear the case. While the Court acknowledged that plaintiff’s arguments on the merits raised important questions, it agreed with defendant that it cannot resolve this dispute. (Opinion)

 

  • Julie Khani, ACLA President, issued the following statement today in repsonse to the District Court opinion: “This is an extremely disappointing outcome for ACLA’s members and the millions of seniors they serve – including the most vulnerable Medicare beneficiaries – who rely on clinical laboratory tests for their most basic health needs. While the District Court’s opinion acknowledges that ACLA’s ‘arguments on the merits raise important questions,’ the District Court refused to consider those arguments, because it erroneously concluded that Congress had stripped it of jurisdiction to do so. The Court’s decision that it is powerless to require HHS to comply with the statutory requirements sets a harmful precedent that allows agencies to circumvent Congress’ express directions at the expense of patient care.” (ACLA.com)

 

  • LabCorp® issued the following statement today regarding the decision from the U.S. District Court for the District of Columbia in ACLA v. Azar: “We are deeply disappointed in the district court’s decision and believe that its conclusion that it did not have the authority to act in this matter is erroneous,” said David P. King, chairman and CEO of LabCorp. “It is, however, important that the court stated that ACLA’s arguments raise ‘important questions’ about CMS's data gathering. The court’s refusal to reach the merits of these important questions makes it critical for Congress to act quickly to force CMS to comply with the law as written. We are evaluating all of our options alongside our industry association ACLA and our industry colleagues to help protect Medicare beneficiaries’ continued access to needed lab testing.” (LabCorp.com)

 

  • Moustafa Moataz Aboshady, a physician and former employee of New England Pain Management Associates, Inc. (NEPA) was convicted by a federal jury on Friday of conspiring to falsify patient medical records between May 2012 and May 2013 in an effort to obtain payments from Medicare and commercial insurers for medical services that were not performed. Aboshady was part of a conspiracy involving other members of NEPA, and members of a satellite office in Cairo, Egypt, whose purpose was to falsify medical records and urine drug test results to support claims for payment to Medicare and insurers for services that Mashali did not render. Part of the conspiracy involved falsification of patient encounter notes. Such false information included, but was not limited to, detailed descriptions of extensive physical examinations and treatment plans, and durations of face-to-face interactions with patients exceeding 20 to 40 minutes per appointment, to create the appearance of lengthy and involved patient encounters, when in fact these services did not take place. Aboshady instructed the Cairo office to create false electronic signatures on the encounter notes and how to make the timestamps for those signatures look realistic. Aboshady was also responsible, in conjunction with the office in Cairo, for the fabrication of urine drug test results with false test dates, so that the tests appeared to have been performed within days of specimen collection rather than weeks or months thereafter. (Justice.gov)

Medicare & Medicaid

  • On Friday, the Centers for Medicare & Medicaid Services (CMS) awarded seven organizations new cooperative agreements to partner with the agency in developing, improving, updating, or expanding quality measures for Medicare’s Quality Payment Program (QPP). These cooperative agreements, authorized under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), represent the first funding initiative supporting public-private efforts to develop measures for the Quality Payment Program. Through these partnerships, CMS will work closely with external organizations—such as clinical professional organizations and specialty societies, patient advocacy groups, educational institutions, independent research institutions, and health systems—to develop and implement measures that offer the most promise for improving patient care. "CMS looks forward to collaborating with these clinicians, patients, and other key stakeholders to identify quality measures that will meaningfully impact patient care. Through our Meaningful Measures initiative, CMS is committed to advancing measures that minimize burden on clinicians, improve outcomes for patients, and drive high-quality care. We need the expertise and firsthand experience of those on the front lines to develop measures that achieve these goals," said CMS Administrator Seema Verma. (CMS.gov)

 

  • The Office of the Actuary at the Centers for Medicare & Medicaid Services has released the 2017 Actuarial Report on the Financial Outlook for Medicaid. This report presents an analysis of past Medicaid trends and 10-year projections of expenditures and enrollment under current law. Of note, the report suggests: "Over the next 10 years, expenditures are projected to increase at an average annual rate of 5.7 percent and to reach $1,005.7 billion by 2026. The Gross Domestic Product (GDP) is expected to grow by an average rate of 4.1 percent. As a result, Medicaid expenditures are projected to increase from 3.1 percent of GDP in 2016 to 3.7 percent of GDP in 2026. The increase in expenditures would place a growing strain on Federal and State budgets." (CMS.gov)

Private Sector

  • Today, at the Association for the Healthcare Environment (AHE) EXCHANGE 2018 annual conference, Clorox Professional Products Company announced that the award winning Clorox® Total 360® System is now available to healthcare facilities across the spectrum of care. While experts agree that thorough cleaning and disinfection of healthcare surfaces and equipment is essential for reducing the risk of infections, studies suggest that only 30 to 50% of surfaces in patient rooms and operating rooms are effectively disinfected and nearly 85% of hospital wheelchairs are contaminated with Staphylococcus aureus or Methicillin Resistant Staphylococcus aureus (MRSA). Using patented electrostatic technology to optimize product delivery, the Clorox® Total 360® System provides an efficient, cost-effective solution to overcome this challenge and enhance environmental hygiene in a wide range of healthcare settings. The Clorox® Total 360® System combines electrostatic technology with U.S. Environmental Protection Agency (EPA)-registered Clorox® disinfecting and sanitizing solutions to quickly and easily provide superior coverage in even the hardest-to-reach places. The innovative system covers up to 18,000 square feet per hour, achieving superior surface coverage up to 75% faster and using up to 65% less product compared with traditional disinfectants per square foot. (PRNewswire.com)

 

 

 

 

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