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CCH® Health Care Compliance Integrated Library
The Health Care Compliance Integrated Library delivers the latest information on health law. The Library includes seven invaluable titles:

• Civil False Claims and Qui Tam Actions - An essential tool for bringing or defending Qui Tam action.
• Clinical Research Compliance Manual: An Administrative Guide - Essential guidance on the laws and regulations affecting clinical research and trials.
• Defending and Preventing Health Care Fraud and Abuse Cases: An Attorney's Guide - Clear, expert guidance on protecting against charges of health care fraud and abuse.
• Health Care Fraud and Abuse Compliance Manual - Giving health care providers a clear perspective on fraud and abuse laws, written in plain-language.
• Health Law and Compliance Update - Find the latest information on emerging issues. Each section is authored by an expert in the area and includes in-depth analysis of the latest health law and compliance issues.
• Hospital Contracts Manual - Expert, current know-how in dealing with numerous hospital contract scenarios.
• Hospital Law Manual - Health Law expertise covering treatment and payment issues in the delivery of health care services.

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Demonstration projects conducted by CMS provide strong evidence that financial incentives for delivering quality care increases quality and can reduce the growth in Medicare expenditures. CMS has announced results from three such demonstrations, one for large physician practices, one for small and solo physician practices, and one for hospitals. CMS has also announced the start of three additional value based purchasing (VBP) demonstrations. The Hospital Quality Incentive Demonstration (HQID), entering its fifth year, shows continued quality improvement among its participating hospitals. Physician practices participating in the Physician Group Practice (PGP) Demonstration continue to improve quality for patients with chronic illnesses or requiring preventive care. More than 560 small and solo physician practices participating in the Medicare Care Management Performance (MCMP) Demonstration are being rewarded for providing high quality care in the delivery of preventive care and care for chronic disease patients. New VBP demonstrations. The VBP initiative is designed to tie Medicare payments to performance as part of an effort to transform Medicare from passive payer to active purchaser. The new VBP demonstration programs include: (1) the Nursing Home Value-Based Purchasing (NHVBP) Demonstration, (2) the Medicare Hospital Gainsharing (MHG) Demonstration, and (3) the Physician Hospital Collaboration (PHC) Demonstration. The NHVBP demonstration program will reward facilities that can improve or deliver high quality care in the areas of staffing, resident outcomes, avoidable hospitalizations and reductions in deficiency citations. The MHG and PHC demonstrations will evaluate whether gainsharing leads to improvements in quality and efficiency. Information on value-based purchasing demonstrations is available at http://www.cms.hhs.gov/DemoProjectsEvalRpts/MD/list.asp CMS News Release, Aug. 17, 2009
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A proposed arrangement under which a state agency would subsidize copayments for outpatient prescription drugs owed by financially needy Medicare Part D enrollees would not constitute grounds for the imposition of civil money penalties or administrative sanctions, according to the Office of Inspector General (OIG). The state agency functions as the planning agency for alcohol, drug addiction, and mental health services. Facts. Under the arrangement, if a patient is eligible for Medicare Part D, an independent mental health center (“center”) contracting with the state agency would determine whether the individual is financially eligible for a Part D copayment subsidy. A patient would be eligible for a Part D copayment subsidy if eligible, on the basis of income and if not a Medicare beneficiary, for subsidized services from the center. If a patient is eligible, the center would inform him or her that the center would pay part or all of the copayment to the pharmacy of the patient’s choice for Part D covered medications. The copayment subsidy would not be advertised. When a Medicare beneficiary enrolled in Part D takes a prescription to be filled, the pharmacy bills the beneficiary’s Medicare drug plan for the cost of the prescription less the applicable copayment. The pharmacy would then bill the center for the copayment subsidy amount. Funds for the copayment subsidies would be provided by the state agency to the centers. These funds could not be used for any other purpose and at the end of the fiscal year, any amounts not used for copayment subsidies would be returned to the agency. The subsidy payment is not contingent on a beneficiary’s choice of any particular Part D plan. Analysis. Here, the state agency would provide something of value (Part D copayment) to the federal health care program beneficiary. The risk is low, however, that this remuneration would influence the beneficiary to choose any particular provider, practitioner, or supplier because: (1) the copayment subsidy would not be advertised, the beneficiary would be screened for eligibility by the center, and at that time, the beneficiary would have already selected the center as a provider; (2) while the provider may assist the beneficiary in enrolling in a Part D plan, the subsidy is not contingent upon the selection of any particular Part D plan; and (3) payment of the copayment subsidy is not contingent upon the use of any particular pharmacy. OIG Advisory Opinion, No. 09-12, Aug. 7, 2009, Health Care Compliance Reporter, ¶500,217
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A proposed arrangement under which a hospital would subsidize an affiliated ambulance cooperative to enable the cooperative to provide certain ambulance services currently provided by the hospital would not constitute grounds for the imposition of civil money penalties or administrative sanctions, according to the Office of Inspector General (OIG). The acute care hospital provides various services, including advanced life support (ALS) services, and is the only hospital in its county that has “comprehensive” emergency services capability. The hospital is part of a nonprofit health system, of which the ambulance cooperative is also a member. The cooperative provides ambulance services in the town and surrounding communities. Its members include the hospital and several local volunteer fire companies. Facts. Under the current arrangement, when the cooperative's basic life support (BLS) ambulance is dispatched together with the hospital's paramedic squad, the cooperative bills the ALS rate, but the hospital does not bill; the cooperative bills the ALS rate when the ALS portion of the ambulance service actually is provided by the hospital paramedic squad, because the cooperative and the hospital are both members of the health system and subject to the health system’s global budget. As a result of this and other billing practices, the hospital recoups only half of the cost of providing ALS services through Medicare and other payers. In contrast, under the proposed arrangement, responsibility for providing the ALS services provided by the hospital and the BLS services provided by the cooperative would be consolidated in the cooperative. Analysis. The proposed arrangement would continue an essential service to the community—ALS ambulance services—currently provided by the hospital at a financial loss. The risk of kickback abuse from the proposed arrangement is low because: (1) the cooperative and its members would receive no benefit from the proposed arrangement; (2) the hospital's donations to the cooperative would not vary with the volume or value of referrals to the hospital by the cooperative; (3) the cooperative and the volunteer fire companies are not in a position to affect referrals in a significant way; and (4) any risk posed by the proposed arrangement is offset by the fact that there are no for-profit ambulance services in the county, given the expense of operating an ambulance service in a sparsely-populated area, and the fact that ALS ambulance services cannot be provided unless subsidized by the hospital. OIG Advisory Opinion, No. 09-13, Aug. 11, 2009, Health Care Compliance Reporter, ¶500,218
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