In a letter written to the Darrell Issa, chairman of the House Committee on Oversight and Government Reform, American Hospital Association President and CEO Richard Umbdenstock details the regulatory burdens facing hospitals.
Mr. Umbdenstock expressed concern over the use of recovery audit contractors and how the misuse of the False Claims Act has forced hospitals to incur "massive expenses" associated with fraud investigations.
Additionally, certain regulations make clinical integration difficult for hospitals, he says. For example, there is a lack of clear and official guidance on how to apply antitrust laws to clinical integration. Also, Mr. Umbdenstock says "compensation arrangements" should be removed from the definition of "financial relationships" under Stark Law. Compensation arrangements, he says, should still be regulated, but by other legislation such as the anti-kickback statute and civil money penalty laws that are "better equipped to do so."
Other regulatory burdens and concerns listed in the letter include the following:
Read AHA President and CEO Richard Umbdenstock's letter to Darrell Issa (pdf).
Read other coverage about healthcare fraud and abuse:
- RACs Can Request Claims Not on Approved List
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Mr. Umbdenstock expressed concern over the use of recovery audit contractors and how the misuse of the False Claims Act has forced hospitals to incur "massive expenses" associated with fraud investigations.
Additionally, certain regulations make clinical integration difficult for hospitals, he says. For example, there is a lack of clear and official guidance on how to apply antitrust laws to clinical integration. Also, Mr. Umbdenstock says "compensation arrangements" should be removed from the definition of "financial relationships" under Stark Law. Compensation arrangements, he says, should still be regulated, but by other legislation such as the anti-kickback statute and civil money penalty laws that are "better equipped to do so."
Other regulatory burdens and concerns listed in the letter include the following:
- Civil money penalty law — Currently, the law prohibits hospitals from rewarding physicians for reducing or withholding medical services to Medicare and Medicaid patients. The law should be revised to have it apply only to the reduction or withholding of medical necessary services, Mr. Umbdenstock says.
- Anti-kickback law — The letter suggests there should be a safe harbor under this law that would allow hospitals to participate in clinical integration efforts and initiatives. Mr. Umbdenstock says Congress should also create a core set of requirements that would protect clinical integration efforts and initiatives from anti-kickback prosecution.
- IRS code — Mr. Umbdenstock also suggests the IRS should issue an advisory or ruling with guidance on how payments from a tax-exempt hospital should be made to physicians in clinical integration programs.
Read AHA President and CEO Richard Umbdenstock's letter to Darrell Issa (pdf).
Read other coverage about healthcare fraud and abuse:
- RACs Can Request Claims Not on Approved List
- RACs Finding Errors in Drug Dosages
- 6 Key Legal Issues Facing Ambulatory Surgery Centers