Law Commons^™

False Claims: The Coordinated Exploitation Of The United States Government By The Healthcare Industry, Grady Mcmichen

Journal of Law and Health

The False Claims Act (FCA) has a long-standing history of protecting the United States government from being defrauded by merchants and other parties submitting claims for repayment. Affording Americans who have enrolled in Medicaid and Medicare expansion plans the same protection afforded to the federal government will allow for action to be brought to prevent large hospital networks from engaging in price-fixing behaviors. Implementing this change will have the effect of reducing healthcare prices for all Americans.

Applying the False Claims Act at the price-fixing level will have the largest affect; however, it is still important to iron out procedures …

Supporting Mothers With Mental Illness: Postpartum Mental Health Service Linkage As A Matter Of Public Health And Child Welfare Policy, Jesse Krohn, Msed, Jd, Meredith Matone, Drph, Mhs

Journal of Law and Health

Through our work in youth advocacy as, respectively, legal and public health professionals, we are all too aware of the high levels of health care fragmentation experienced during pregnancy and postpartum by poor, young mothers of color. Meredith Matone’s research highlights the heightened risk of fragmentation for girls with histories of child welfare involvement. For example, she found that 66.7% of young mothers who had resided in out-of-home placements and who had taken antipsychotic medication prior to becoming pregnant failed to fill prescriptions for antipsychotics in their first postpartum year. Put another way, two-thirds of these vulnerable young mothers—a far …

Will Uncooperative Federalism Survive Nfib?, Abigail R. Moncrieff, Jonathan Dinerstein

Law Faculty Articles and Essays

In the end, the Supreme Court's federalism jurisprudence seems to run contrary to its stated goals. The New Federalism era, up to and including NFIB, creates an incentive for the national government to flex its own muscles more, not less. Maybe that result will be good for voters' clarity and for uniformity of national policy, but it is not good for uncooperative federalism or for states' autonomy—the values that the Supreme Court seems to be trying to protect.

Medicaid Expansion, The Patient Protection And Affordable Care Act, And The Supreme Court's Flawed Spending Clause Coercion Reasoning In National Federation Of Independent Business V. Sebelius, L. Darnell Weeden

Cleveland State Law Review

The issue to be addressed is whether the Patient Protection and Affordable Care Act’s (ACA or “Obamacare”) manifest goal of promoting the general welfare of the nation by encouraging states to expand their existing Medicaid plans is a coercive use of Congress’ power under the Spending Clause if the federal government permanently picks up at least 90 percent of the cost of the expansion. The Spending Clause grants Congress the power “to pay the Debts and provide for the . . . general Welfare of the United States.” To make certain that federal money given to the States is used …

Kicking Ohio Medicaid Recipients When They Are Down: How Ohio's Third Party Liability Medicaid Statute Violates Federal Law As Interpreted By Ahlborn, Kelly Voyles

Cleveland State Law Review

This Note argues that Ohio’s Medicaid third party liability statute must either be invalidated by the Ohio Supreme Court or repealed by the Ohio General Assembly. This Note then goes on to argue that the Ohio General Assembly must amend its Medicaid third party liability statute to require settlement allocation before ODJFS can recover the medical payments it made on behalf of Ohio Medicaid recipients. Finally, this Note argues that Ohio should also amend its Medicaid third party liability statute to require that the parties come to an allocation agreement themselves or, if that proves impossible, to require a judicial …

The Positive Case For Centralization In Health Care Regulation: The Federalism Failures Of The Aca, Abigail R. Moncrieff, Eric Lee

Law Faculty Articles and Essays

Although the ACA accomplishes significantly greater centralization of authority for healthcare regulation, it falls far short of the full centralization that seems functionally justified. There is no doubt that the states have played an important role in healthcare regulation throughout the nation's history, but that role is becoming increasingly irrelevant as healthcare regulation becomes increasingly technocratic—i.e., increasingly objectivist and data-driven. The ACA is a step in the right direction, but the U.S. should further centralize authority over healthcare.

The Supreme Court’S Assault On Litigation: Why (And How) It Could Be Good For Health Law, Abigail R. Moncrieff

Law Faculty Articles and Essays

In recent years, the Supreme Court has narrowed or eliminated private rights of action in many legal regimes, much to the chagrin of the legal academy. That trend, although certainly not limited to health law, has had a significant impact on the field; the Court's decisions have eliminated the private enforcement mechanism for at least three important healthcare regimes: Medicaid, employer-sponsored insurance, and medical devices. In a similar trend outside the courts, state legislatures have capped non-economic and punitive damages for medical malpractice litigation, weakening the tort system's deterrent capacity in those states. This Article suggests that the trend of …

Federalization Snowballs: The Need For National Action In Medical Malpractice Reform, Abigail R. Moncrieff

Law Faculty Articles and Essays

Because tort law and healthcare regulation are traditional state functions and because medical, legal, and insurance practices are localized, legal scholars have long believed that medical malpractice falls within the states' exclusive jurisdiction and sovereignty. This conventional view fails to consider the impact that federal healthcare programs have on the states' incentives to regulate. As a result of federal financing, each state externalizes some of the costs of its malpractice policy onto the federal government. The federal government therefore needs to take charge of medical malpractice in order to fix the spillover problem created by existing federal healthcare programs.

Importantly, …

The Deficit Reduction Act Of 2005 - Reducing The Number Of Recipients And Applicants Eligible To Receive Medicaid Benefits, Christal Contini

Journal of Law and Health

Medically impaired individuals such as George, as well as disaster victims, mentally handicapped persons, homeless persons, and foster children, will be adversely affected by the new citizenship documentation requirements imposed upon the states by the Act. States will also be adversely affected by the increased administrative costs of implementing the Act's requirements. This note asserts that aspects of the citizenship verification requirements treat citizen applicants worse than immigrant applicants, which violates the Due Process Clause of the Fifth Amendment. Amendments should be made to the United States Code and the Code of Federal Regulations to ease the burden on individuals …

From Concierge Medicine To Patient-Centered Medical Homes: International Lessons And The Search For A Better Way To Deliver Primary Health Care In The U.S, Gwendolyn R. Majette

Law Faculty Articles and Essays

This paper will proceed in eight parts. Part II explores why primary care is a critical component of a country's health care delivery system. Part III describes patient and physician dissatisfaction with the current state of primary care delivery in the United States. Parts IV and V describe physician-designed solutions and Congress' responses to them. Part VI describes the role of primary care in the delivery of health services in the international context by focusing on the World Health Organization's Health for All policy and the policies supporting primary care in the United Kingdom, the Netherlands, and Belgium. Part VII …

Payments To Medicaid Doctors: Interpreting The “Equal Access” Provision, Abigail R. Moncrieff

Law Faculty Articles and Essays

This Comment analyzes the circuit split that has arisen as courts have confronted challenges to Medicaid payments. Part I provides background on the Medicaid program and the circuit split, and it identifies and explicates two competing rules for measuring adequacy of Medicaid payments: the Fifth and Seventh circuits' "access metric" and the Ninth Circuit's "cost metric." Parts II and III identify problems with these two rules, and criticizes them as inconsistent with the statute's text, purpose, and intent. Part IV proposes a new rule, an "MCO metric," and explains why that rule is the best interpretation of Medicaid's reimbursement provision.

The Medicaid Cost Crisis: Are There Solutions To The Financial Problems Facing Middle-Class Americans Who Require Long-Term Health Care, Kenneth Hubbard

Cleveland State Law Review

Medicaid was originally designed as a welfare program to provide healthcare to the poor. Despite the initial intentions of Congress, Medicaid has instead become "a multi-billion-dollar insurance policy" for elderly middle-class Americans who require long-term health care. The Medicaid crisis has been described as "a battle between elderly people's desire for long-term care coverage and their concomitant reluctance to pay for it themselves." This battle is waged between the older and younger generations, commencing when the younger generation observes that their inheritance is growing smaller or disappearing altogether due to the immense cost of their parents' long-term health care.