Law Commons^™

The Problem With Value-Based Purchasing, Craig B. Garner

Craig B. Garner

From its inception on October 1, 2012, the Hospital Value-Based Purchasing (“VBP”) Program shifted Medicare’s paradigm to emphasize performance over costs in determining hospital reimbursement. Reducing the overall Medicare reimbursement to hospitals by an estimated $1.4 billion for Fiscal Year (“FY”) 2015, the VBP Program was quick to secure the attention of the nation’s health care providers. Technically “budget neutral,” the VBP Program will return this same $1.4 billion to hospitals the following year in the form of performance incentives. As the Federal Government waits to assess the accuracy of its prediction, the FY 2015 reduction of 1.50% will finally …

Cgmp Violations Should Not Be Used As A Basis For Fca Actions Absent Fraud, Kyle Faget

Seattle University Law Review

Since Congress amended the False Claims Act (FCA) in 1986, the statute has evolved into a seemingly boundless weapon for enforcing other statutes and regulations applicable to every industry that accepts any form of government funding. Use of the FCA by the Department of Justice (DOJ) and by private citizens bringing actions on behalf of the U.S. government to enforce other statutes and regulations is particularly evident in the field of health care. The FCA has been utilized in actions where the allegations include off-label promotion of drugs, kickbacks, and violations of current good manufacturing practices (cGMPs) by linking the …

I Need A Doctor: A Critique Of Medicare Financing Of Graduate Medical Education, Stacey A. Tovino

Washington and Lee Law Review

In its broadest sense, this Article examines the complex relationship between population booms, doctor shortages, and United States government financing of graduate medical education (GME). More specifically, this Article argues that current rules governing the calculation of Medicare payments to teaching hospitals for the costs of GME are based on cost, population, and other data that are no longer relevant. As applied, these formulas discriminate in favor of the nation’s oldest teaching hospitals, located in New England and the Middle Atlantic, and against current and future teaching hospitals located in growing population centers, especially regions in the South and West. …

Medicare: The Perpetual Balance Between Performance And Preservation, Craig B. Garner

Craig B. Garner

Passed by Congress and signed by President Lyndon Johnson into law in 1965, Medicare has weathered storms from all directions, growing to be the preeminent standard for health insurance in the United States. The idea of losing Medicare as a vital public benefit still remains the single greatest fear with which each passing generation of Americans must contend, and yet, these challenges over the past fifty years, designed to fortify Medicare’s foundation and ensure its longevity, continue to take a toll on the program. The most recent climate of reform includes changes implemented by the Patient Protection and Affordable Care …

The Medicaid Gamble, Ann Marie Marciarille

Faculty Works

The Patient Protection and Affordable Care Act (ACA) was an unprecedented gamble. The ACA transformed Medicaid from an unevenly and underfunded program for the poor and disabled to a program to offer those priced out of commercial insurance markets government-funded health insurance similar to Medicare, the single-payer system for seniors and the disabled. In a sense, the ACA gambled that Medicaid could be more like Medicare.

The ACA, as it was transformed by the Supreme Court of the United States, became a gamble on the part of the Court that good things would follow from empowering each of the states …

Response To: "Pay-To-Play: The Impact Of Group Purchasing Organizations On Drug Shortages", Curtis Rooney

American University Business Law Review

No abstract provided.

Observing Observational Status -- Auditors And Inequities

Marquette Elder's Advisor

No abstract provided.

I Need A Doctor: A Critique Of Medicare Financing Of Graduate Medical Education, Stacey A. Tovino

Scholarly Works

In its broadest sense, this Article examines the complex relationship between population booms, doctor shortages, and United States government financing of graduate medical education (GME). More specifically, this Article argues that current rules governing the calculation of Medicare payments to teaching hospitals for the costs of GME are based on cost, population, and other data that are no longer relevant. As applied, these formulas discriminate in favor of the nation's oldest teaching hospitals, located in New England and the Middle Atlantic, and against current and future teaching hospitals located in growing population centers, especially regions in the South and West. …