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The Affordable Care Act

The Affordable Care Act

The Patient Protection and Affordable Care Act (known as The Affordable Care Act or ACA) was signed into law by President Obama on March 23, 2010. The United States Supreme Court heard arguments regarding the constitutionality of the ACA, and upheld the law on June 28, 2012. While repeal of ACA was a fairly large campaign issue for Governor Romney during the election, the ACA is re-confirmed as law of the land as President Obama was re-inaugurated on January 21, 2013.
The ACA is one of the most far reaching and aggressive acts signed into law in terms of health care. It includes provisions such as Medicaid Expansion, the individual health insurance mandate, removal of lifetime insurance limits, medical device tax, and a slew of anti-fraud initiatives. In short, the ACA touches everyone’s life in one way or another.

Since the passage of ACA, there have been a multitude of rules, approximately 180, issued under its authority. These rules come from not only the Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS), but other agencies as well like the Internal Revenue Service (reducing the number of hours required for full-time employees). One of the regulations issued by HHS and CMS implements what is known as the Hospital Inpatient Value-Based Purchasing Program (VBP). VBP is intended to transform Medicare from a passive payer for services to a prudent purchaser of services, paying not just for quantity of services but for quality as well. The hospital will essentially be ‘scored’ on a variety of data sets, and will be rewarded with an incentive payment if it meets certain goals.

But the ACA not only transforms Medicare towards a quality over quantity payer, it also empowers the Government with tools needed to ensure that the limited Medicare and Medicaid dollars are spent wisely. But don’t take our word for it. The Secretary of HHS, Kathleen Sebelius, said “Thanks to the new tools and resources provided under the Affordable Care Act, we are more effective at going after the fraudsters that are stealing taxpayer dollars.” Government reports claim that there is anywhere from sixty to ninety billion dollars in waste, fraud and abuse in the Medicare/Medicaid programs every year. To help combat that, the ACA appropriated an additional one hundred million dollars for anti-fraud initiatives, and the Health Care and Education Reconciliation Act (HCERA) earmarked an additional two hundred and fifty million. As a result, the auditors have been unleashed with this push for anti-fraud and recovery of program overpayments. The Zone Program Integrity Contractors (ZPIC) audits have been unprecedented. ZPICs investigate fraud and proactively analyze data to identify fraud and other program vulnerabilities. Recovery Audit Contractors (RAC) are in every state looking for overpayments, and they are paid on a contingency basis from overpayments the RAC recoups.

But wait, there’s more! The American Taxpayer Relief Act of 2012 (remember the fiscal cliff?) included provisions that would allow RACs to audit five years back, instead of a prior three year limitation. We expect that future legislation will continue to give ACA more teeth in fighting fraud and overpayments, and it is highly likely that future legislation will continue to expand Medicare and Medicaid in the availability of services and to increase qualified beneficiaries.
If you would like more information, contact one of our experienced health care attorneys today. Stay tuned to our website for updates on the Affordable Care Act and its regulations.