'Fraud and Abuse' Back Atop List of Top 10 Health Law Priorities in 2011

All Issues on List Will Likely Be Affected by New Health Care Reform Provisions

ARLINGTON, Va., Jan. 10, 2011 /PRNewswire-USNewswire/ -- The convergence of regulatory and compliance challenges driven in large degree by the health reform law, an aggressive government enforcement stance, and budget deficits at all levels of government make fraud and abuse the top health law issue for 2011, according to a survey of 25 health law practitioners from BNA's Health Law Reporter advisory board conducted in December, 2010.

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Survey respondents said the focus on enforcement of fraud and abuse laws stems from a deluge of regulations to implement new health care industry reforms and the push by state and federal governments to offset outlays with monies from settlements and recoveries obtained in enforcement actions. They also cited the dual threat of individual liability for corporate wrongdoing and increased whistleblower clout as raising serious concerns for health care organizations seeking to avoid the fraud and abuse spotlight.

Board members also said the complex changes wrought by health reform, and the regulation of the accountable care organizations (ACOs) that are considered by many to be central to its success, will require a revamp of antitrust, tax, and fraud and abuse regulations to permit the level of clinical integration and coordination of care ACOs need to be effective without running afoul of current laws. Several questioned, however, whether government guidance actually will clarify which types of provider collaborations will pass a regulatory "litmus test."

The interest in ACOs and questions about their potential effect on competition, as well as concern about antitrust law enforcement generally, made antitrust second in board members' ranking of the Top 10 issues facing health lawyers in 2011. Rounding out the list were Medicare/Medicaid programs, health plan regulation, protection of health information, the need for better patient care quality and its effect on the provider's bottom line, medical staff issues, taxation, corporate governance, and labor and employment issues. All of the cited issues were seen by board members as likely to be affected by health care reform for the foreseeable future.

One board member predicted that compliance challenges will grow more numerous, complex, and interrelated, with health lawyers feeling more and more "as if we are squeezing a balloon; as soon as we understand and adjust to one issue, the solution may cause another to pop out the other side of the balloon, demanding attention to one or more other issues."

BNA is the leading independent publisher of print and electronic news and information for professionals in business and government. BNA produces more than 300 news services, including the highly respected Daily Labor Report, Health Care Policy Report, Health Law Reporter, and Medicare Report. Visit BNA online at www.bna.com.  

SOURCE BNA