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Physicians must protect themselves from increased prosecution under health care reform legislation
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 Alan E. Reider |
KAANAPALI, Hawaii — Ophthalmologists must prepare themselves and their practices for what could be surprising effects of recent changes to health care legislation, according to an attorney speaking here.
During a combined general session at the Hawaiian Eye and Retina 2011 meeting, Alan E. Reider, JD, MPH, outlined some of the more notable enforcement changes forthcoming under the Patient Protection and Affordable Care Act.
"The first and most significant portion of health care reform is increased funding over the next 10 years for enforcement," Mr. Reider said.
Health care reform legislation will increase enforcement funding $350 million over 10 years, according to Mr. Reider.
"That's a lot of investigators, a lot of auditors, a lot of prosecutors and a lot of grief, because we have Congress beating on the administration, saying you're not doing enough, and now part of health care reform legislation is going to increase enforcement activity dramatically," Mr. Reider said.
Another enforcement area physicians should take note of is an amendment to the anti-kickback statute.
"Now the new legislation reduces the burden of prosecutors, making it much easier to prosecute under the anti-kickback statute," Mr. Reider said. "So, while we have all heard about how we need to be careful about it, the practical reality is that ... I feel that this change will result in an increase in cases or a threat of an increase."
Physicians also need to be aware of expansion to the False Claims Act, Mr. Reider said.
As a result of these enforcement changes and others, Mr. Reider recommended that all ophthalmologists perform an annual billing and coding review, confirm that their contractual relationships with referral sources are up to par with the latest rulings, and assure that their financial relationships with pharmaceutical and device companies are proper, particularly if they become public.
Additionally, establishing a compliance program is necessary as mandated by new legislation for enrollment in Medicaid and Medicare for all providers and suppliers, he said.
- Disclosure: Alan E. Reider, JD, MPH, has no relevant financial interest to disclose.
Hawaiian Eye and Retina 2012 will be held January 15-20 at the Grand Wailea Resort & Spa in Maui. Learn more at OSNHawaiianEye.com or RetinaMeeting.com.