Over the years our firm has periodically sent out a newsletter to advise our clients and friends about recent changes, trends and happenings in the healthcare field.  We are pleased to share the August issue of our newsletter with you.  Periodically, we will do our best to share with you "insight" that we find helpful in our practice and that should be helpful for you in yours. 

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Jay B. Umansky
The Law Offices of Jay B. Umansky PC 

OCTOBER 10, 2018
8:00 a.m. - 11:00 a.m. 
Want to maximize recovery on your healthcare receivables? Join attorneys Jay Umansky and Andrew Babitz as they host a Breakfast Seminar to show you how to maximize recovery on third party liability liens, worker's compensation underpayment, difficult commercial insurance issues and outstanding self-pay balances . RSVP to Andrew Babitz at by September 20, 2018.  We can't wait to see you there.

CMS to Review Stark Law Relevance Once Again
By Jessica L. Bailey-Wheaton, Esq., Editor 
Health Capital Consultants 
July 2018 

On June 25, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a Request for Information (RFI) related to the regulatory burden of the physician self-referral law (known as the Stark Law), on both providers and the overall healthcare industry.1 The aim of this request is to determine whether revision(s) of healthcare fraud and abuse laws is needed in order to remove any regulatory impediments to the accelerating shift toward value-based reimbursement (VBR) and coordinated care, and further innovation in the U.S. healthcare delivery system.
Government regulators perceive many types of healthcare business arrangements, which in other industries are often seen as typical motivations in commercial relationships, as exhibiting the potential for a significant risk of fraud. For example, referral relationships, which in other industries are lawful and exhibit the potential for increased profit, may violate federal fraud and abuse laws, such as the Stark Law, when existing between healthcare providers. However, there is an inherent conflict between fraud and abuse laws and VBR, as the pursuit of VBR and coordinated care by providers has driven the pursuit of closer relationships between hospitals (that are seeking to amass the various specialties needed to provide a full continuum of care in a cost-effective manner) and physicians (who are experiencing tightening reimbursement at the same time that they are being required to heavily invest in healthcare information technology for quality reporting purposes), through various alignment strategies, e.g., practice acquisitions, direct employment, provider services agreements (PSAs), co-management, and joint venture arrangements.
One result of provider alignment in pursuit of VBR goals, particularly when aligning through employment arrangements with hospitals and health systems, may be that hospitals or health systems sustain practice losses.3 This may be due to a number of reasons, including: (1) encountering a more adverse payor mix in a hospital setting; (2) needing to pay more competitive salaries to employed providers; and, (3) the treatment of ancillary services by the hospital or health system (i.e., treating vertically integrated physician practices as stand-alone economic enterprises, which, when stripped of their ancillary service and technical component (ASTC) revenue, and relying solely on professional services, i.e., work relative value unit [wRVU] related revenue, and paying physicians at FMV, are almost certain to generate "book financial losses").4 Corresponding with this increased provider alignment, there has been enhanced federal, state, and local regulatory oversight regarding the legal permissibility of these arrangements.5 Most notably, there has been more intense regulatory scrutiny related to the Anti-Kickback Statute and the Stark Law, especially as these fraud and abuse laws relate to potential liability under the False Claims Act (FCA).6

Lower the cost of health care? Here's what Missouri Influencers have to say

By Andy Marso
Kansas City Star
August 13, 2018 

The Star asked the Missouri Influencer panel to respond to readers who said their biggest healthcare issue is lowering the cost of health care and making it accessible for all, including those with pre-existing conditions. The question for the Influencers: What can policymakers do?

Mark Bedell, Kansas City Public Schools superintendent: "Policy makers have to continue to push the conversation at the federal level from both sides of the fence."

John Hancock, political consultant, former Missouri GOP chairman: "Tort reform, removal of coverage mandates to allow the purchase of catastrophic coverage, encouragement of HSAs.

Patrick Tuohey, Show-Me Institute director of municipal policy: "The best way to maintain quality while reducing cost is to allow as much free market competition as possible - including transparent pricing. This itself is not sufficient, but it is a necessary first step to addressing other important concerns such coverage for as pre-existing conditions."

Jay Nixon, former governor: "Begin in a much more robust fashion the use of technology to get better outcomes and lower costs. Much of technology in healthcare is simply focused on billing."

Editorial: Can Amazon save American healthcare?
The Los Angeles Times 
Editorial Board
January 31, 2018 

Berkshire Hathaway Chairman Warren Buffett is known as a "value" investor - someone who buys into companies that are selling for less than they're really worth. When his company provides its workers healthcare benefits, however, Buffett isn't paying for value. Instead, employers like Berkshire, which owns a diverse portfolio of financial and industrial companies, are paying ever-higher amounts for their workers' policies and getting less coverage in return

That problem helped drive Berkshire Hathaway to announce plans Tuesday to join forces with online retail giant Amazon and Wall Street powerhouse JPMorgan Chase & Co. to create an independent venture that aims to reduce their healthcare costs while improving employee satisfaction. Notably, they said the new company will be "free from profit-making incentives and constraints."

What this new company will do, though, is anybody's guess. "Our group does not come to this problem with answers," Buffett conceded. Nevertheless, it's a welcome signal that companies are finally trying to rein in the rising cost of healthcare, rather than simply passing more of the pain on to their employees.

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Jay B. Umansky, Principal Attorney - - 314-628-1177 X 101
Andrew F. Babitz, Associate Attorney - - 314-628-1177 X 103
Kellie L. Roland, Office Administrator - - 314-628-1177 X 102