New Jersey Healthcare Blog

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Government Coercion As A Vehicle To Alter Healthcare

The front page of the New York Times on Tuesday, October 18, 2011 stated that the Massachusetts Legislature, which previously mandates health insurance for all, has now moved into its next stage of attempting to contain the cost of healthcare.  One way of containing the cost that has been applied around the globe is to […]

Healthcare Reform Developments

Over the last several weeks different events have occurred which will have an impact on the new healthcare system under the Affordable Care Act (ACA). There has been an acknowledgement and recognition by CMS officials that the portion of the ACA known as the CLASS Act is actuarially unsound and cannot be realistically implemented.  What […]

Breaking News: CMS publishes Final ACO Regulations

Today was a busy day indeed for CMS.  The agency has released the following: (1) the final Shared Savings Program regulations for ACOs; (2) a solicitation for participation in a new Advanced Payment Model designed to provide upfront payments to certain ACOs to assist with upfront infrastructure costs; and (3) a proposed rule implementing reforms […]

Criminalizing Medicare

At a recent meeting of the American Health Lawyers Association in Boston, the representatives of various government agencies, the U.S. Attorney’s office from various states, the Justice Department representatives, the OIG representatives and the Attorneys from CMS all made a similar point.  That point was very simple, it is their feeling that recoupment, debarment, and […]

Another Round of Potential Physician Reimbursement Reductions

On July 1, 2011, the Centers for Medicare and Medicaid Services (“CMS”) published proposed changes to the Medicare physician fee schedule for calendar year 2012.  CMS announced that absent a change in law, Medicare payments to physicians would be reduced by 29.5% effective January 1, 2012 as a result of the application of the sustainable […]

Government Stepping Up Criminal Enforcement Efforts

At the American Health Lawyers Association (AHLA) conference in Boston last week, the presenters, particularly those from the Justice Department or Centers for Medicare & Medicaid Services (CMS), consistently made the following position clear:  there will be more criminal enforcement activity in the healthcare arena. The government believes that civil monetary penalties, recoupment, and debarment […]


In a prior blog, we discussed the CMS report regarding the projected solvency of the Medicare Program.  As we previously reported, CMS has projected the solvency of Medicare through 2024.  However, a reading of the report shows that to accomplish this goal, payments to physicians as of January 1, 2012 need to be reduced by […]

Medicare Solvency: A Continuing Challenge

The Medicare Board of Trustees recently projected that the Medicare program will be insolvent in 2024.  Unfortunately, the news may be even worse than that.  If you read pages 265-267 of the Trustee’s report which is the Actuarial Opinion, there are two (2) critical assumptions being made by the Trustees in order for the Medicare […]

Accountable Care Organizations

Dr. Donald Berwick, Administrator of CMS, has recently written about the potential benefits of Accountable Care Organizations (ACO’s), ( as is set forth in the attached article one of the hurdles facing the provider community is that ACOs will cost millions of dollars that are unlikely to be recouped (at least in the short term). […]

Sustainable Growth Rate

Attached is an article from the American Medical News in regard to the Sustainable Growth Rate (SGR) formula and its application to the Medicare physician fee schedule.  This issue is still on the table and is moving to the forefront again.  The result of the application of the SGR would be a 29.5% cut in […]

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