Mid-Atlantic Health Law TOPICS

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Did You Know? Fall 2002

Resident Matching: Did you know that a class-action lawsuit has been filed challenging the National Resident Matching Program on antitrust grounds? The suit alleges that more than 1,000 hospitals have used the program to keep hospital residents' wages low. Under the program, which matches each applicant to one hospital, there is no room for negotiations about wages or other terms of employment.
Resident Hours: Did you know that the Accreditation Council for Graduate Medical Education (ACGME) has limited (1) the resident work week to 80 hours; (2) call duty to every third night; (3) on-call duty to 24 hours, with an additional 6 hour period for transfer of care and educational activities? Residents are also to receive one day off a week, as well as a 10-hour rest period between shifts. Resident programs may increase the work week hours by up to 10 percent, if the program deems such increase is in the resident's educational best interest. ACGME requires compliance by July 1, 2003. Though ACGME acknowledges that these changes will likely be very costly for hospitals employing residents, ACGME insists that quality care demands the changes.
Intermediary Fraud: Did you know that a one-time Medicare intermediary, General American Life Insurance Company, recently agreed to pay $76 million to settle charges of Medicare fraud? General American processed Part B claims for Medicare, and allegedly knowingly provided false information to the Centers for Medicare & Medicaid Services (CMS), including concealing its claims error rate. The government's charges stemmed from a whistleblower lawsuit filed by two former employees, who will collect approximately $14 million as part of the settlement. The settlement is significant because it shows the government's willingness to go after intermediaries, and not just providers, for Medicare fraud.
Kansas Blues About Face: Did you know that the Kansas State Commissioner of Insurance's decision to turn down a proposed takeover of Blue Cross and Blue Shield of Kansas by Indiana-based Anthem Inc. was overturned by a Kansas district court judge in June of 2002? The Commissioner had denied the takeover in February of 2002, because in her opinion the takeover would cost Kansans millions of dollars in increased premiums, and would threaten local health care decision-making. The district court held that, since Kansas law neither prohibits higher premiums nor distant decision making, the takeover could not be blocked because of such factors. This matter is not yet settled, however, since the Kansas Supreme Court has decided to consider the case.
HIPAA Extension Request: Did you know that, if you are a health care provider, health plan (insured or self-funded), or a billing clearinghouse, and you are not ready to send and receive transactions electronically in conformity with HIPAA transaction and code set standards by October 16, 2002, then you must file an extension request (referred to as a compliance plan) by October 15, 2002? Covered entities may file for an extension using the form available at www.cms. hhs.gov/hipaa/hipaa2/ASCAForm.asp.


September 22, 2002




Rosen, Barry F.


Health Care