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Legal news from Friday, November 2, 2012 |
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Federal government sued over privatized Medicare audits
Julia Zebley on November 2, 2012 2:02 PM ET

[JURIST] Five hospitals filed a lawsuit [complaint, PDF] against the US Department of Health and Human Services [official website] in the US District Court for the District of Columbia [official website] Thursday over what they contend is a scheme to deny them reimbursement from Medicare [official website] for necessary medical services. The coalition, led by the American Hospital Association (AHA) [advocacy website; case backgrounder], alleges that Recovery Audit Contractors (RAC) [official profile], private contractors that assess overpayment and underpayments in Medicare reimbursements, are encouraged to prevent hospitals from obtaining appropriate reimbursements. The AHA argues that because RACs—which are managed by four private corporations that are then assigned to hospitals based on regional location—are paid on contingency fees they have a vested interest in denying funding. The complaint cites several examples where an RAC admitted that the patient's treatment was necessary, but should have been provided on an outpatient basis, and thus the hospital is denied reimbursement or expected to return previous reimbursements.The RACs are frequently wrong in their assertions about what a physician, confronted with a patient in need of medical treatment, should have done months or years earlier. Indeed, hospitals report that when they pursue appeals through the administrative appeals process—an expensive and burdensome exercise—they are successful in overturning RAC denials 75 percent of the time. Despite this alarming error rate, when a RAC determines that a provider was paid for inpatient hospital services but that the patient in question should have been treated as an outpatient, [Centers for Medicare & Medicaid Services] takes back the entire Part A payment. Moreover, CMS takes the position that once an inpatient claim that was paid under Medicare Part A is later—usually years later—denied, the hospital cannot receive Medicare Part B payment except for a few ancillary services. As a result, when a RAC concludes that a hospital should have provided items and services on an outpatient, rather than an inpatient, basis, the hospital ends up receiving little if any reimbursement for reasonable and medically necessary items and services provided. The RACs fare significantly better. They keep a contingency percentage—9 percent to 12.5 percent—of the entire Part A payment. The Centers for Medicare & Medicaid Services (CMS) [official website] declined to comment [Reuters report] on the suit.
RACs were made permanent through the Tax Relief and Health Care Act of 2006 [text] and were controversial at the time of enactment. RACs have a three-year lookback period and are the only Medicare audit option for hospitals in all 50 states. They were implemented in 2008 [press release], with the CMS describing their goal as "to identify improper payments made on claims of health care services provided to Medicare beneficiaries." In the CMS's 2010 report to Congress [pdf] it determined that RACs had "identified and corrected $92.3 million in combined overpayments and underpayments," with 82 percent being overpayments that were returned to the Medicare Trust Fund [Medicare backgrounder, PDF].


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ICC finds Ivory Coast ex-president fit to stand trial for crimes against humanity
Dan Taglioli on November 2, 2012 11:58 AM ET

[JURIST] Pre-Trial Chamber I of the International Criminal Court (ICC) [official website; JURIST backgrounder] on Friday found former Ivory Coast president and alleged war criminal Laurent Gbagbo [BBC profile; JURIST news archive] fit to stand trial [decision, PDF; press release]. In August Pre-Trial Chamber I postponed Gbagbo's confirmation of charges hearing [JURIST report] in order to determine if the former president remains fit for trial. Three medical evaluations of Gbagbo's fitness were submitted on July 19, around three weeks after the Chamber appointed three medical experts following a defense request. The court-appointed panel of experts who examined Gbagbo determined that he was healthy enough to take part in the proceedings:As indicated above, the Chamber considers that Mr Gbagbo is not physically unfit to take part in the proceedings against him. ... The Chamber ... bases its conclusions on Mr Gbagbo's mental fitness mainly on the written report and testimony of Dr Lamothe, which establish that Mr Gbagbo possesses the capacities to understand the charges against him, as well as the conduct and the possible consequences of proceedings against him, and is capable of giving instructions to counsel as well as of making a statement. Gbagbo is charged [ICC arrest warrant, PDF] with crimes against humanity on four counts including murder, persecution, inhumane acts and rape and other forms of sexual violence allegedly committed during the 2010 post-election violence in which Gbagbo lost but refused to cede power. Gbagbo's rival President Alassane Ouattara [BBC profile; JURIST news archive] was declared the winner of the 2010 election and is now president.
The violence that followed the 2010 election claimed approximately 3,000 lives. Earlier this week the ICC denied Gbagbo's motion asking the court for allowance to leave the Netherlands while he recovers from alleged maltreatment received while detained by national authorities in the Ivory Coast before being surrendered to the ICC [JURIST reports] in November. The court denied Gbagbo's leave request upon a determination that he posed a flight risk. In August the ICC dismissed a jurisdiction challenge [JURIST report] by Gbagbo, ruling that the court has the authority to hear the case. Also that month ICC The court first postponed Gbagbo's confirmation of charges hearing in June, after his lawyers asked the court more time to prepare [JURIST reports], complaining that they did not have enough resources to build their case in the amount of time given. Gbagbo's original hearing date was set [JURIST report] in December during his pre-trial hearing in ICC Pre-Trial Chamber III.


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Russia Internet regulation law takes effect
Michael Haggerson on November 2, 2012 11:34 AM ET

[JURIST] A controversial Russian Internet regulation law which gives the Russian government the ability to completely block access to certain websites went into effect on Thursday. The bill's stated purpose is to block access [Moscow Times report] to child pornography and the encouragement of drug use or suicide. Reporters Without Borders (RSF) [advocacy website] criticized [press release] the law, however, because of its vague definition of what content is banned and the unclear process of how websites are chosen to be blacklisted. Under the law, an undefined and anonymous group of experts picks which websites are blacklisted and an entire website can be banned if even a single page has material deemed to be offensive. Individuals can check which websites are banned on a government website [materials, in Russian]. RSF also expressed concerns that this law was just a single part of a series of legislation designed to restrict the right of freedom of information and called on the Russian State Duma [official website, in Russian] to halt its attempts to stop the dissemination of information.
Internet freedom remains a controversial issue around the world. The UN Human Rights Council in July passed its first-ever resolution to protect the free speech [JURIST report] of individuals online. The resolution was approved by all 47 members of the council, including China and Cuba, which have been criticized for limiting Internet freedom. In June the Chinese Ministry of Information and Technology revealed its proposed changes to Chinese Internet law [JURIST report] that seek to limit the ability of users to post anonymous comments on micro-blogs and forums. A Bangkok criminal court in May sentenced [JURIST report] Chiranuch Premchaiporn, webmaster of independent Internet news site Prachatai, to an eight-month suspended sentence for failing to delete defamatory comments against Thailand's royal family. Earlier that month, a Dutch court ordered [JURIST report] Internet service providers in the Netherlands to block the file-sharing website The Pirate Bay or else pay a fine of USD $12,750 per day.


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Supreme Court hears arguments in Sixth, Fourth Amendment cases
Julia Zebley on November 2, 2012 9:31 AM ET

[JURIST] The US Supreme Court [official website] heard oral arguments [day call, PDF] in two cases Thursday. In Chaidez v. United States [transcript, PDF; JURIST report] the court heard arguments to determine if Padilla v. Kentucky [JURIST report] applies retroactively to persons whose convictions became final before its announcement. Padilla held that the Sixth Amendment [text] guarantee of effective assistance of counsel requires a criminal defense lawyer to advise a non-citizen client that pleading guilty to an aggravated felony will trigger mandatory, automatic deportation. In this particular case, petitioner Roselva Chaidez's attorney's advice to take a plea deal resulted in her deportation. She contends had she known deportation was possible, she would not have taken his advice. The attorney for Chaidez argued that Padilla was just an application of the longstanding precedent in Strickland v. Washington [text] and thus the more than 10 contrary circuit court decisions that were issued before Padilla was announced are incorrect.Well, let me—let me try to work with your hypothetical. I think what I hear your hypothetical to say is that prevailing norms change, and they evolve to a certain point where certain kinds of advice is required, which is much what this Court said in Padilla about—about deportation advice. You would have—you would not have a new rule to simply recognize that at the time that attorney gave advice, that—that Strickland was violated. It would be a new rule, I think, Justice Kennedy, to say that Strickland requires relief, even though at the time the advice was given the prevailing norm had not yet crystalized into the degree that this Court requires. The Solicitor General argued that the previous decision interpreted Strickland correctly and that Padilla created a new rule that could not be applied retroactively.
The court also heard arguments in Bailey v. United States [transcript; JURIST report] on whether police officers may lawfully detain individuals incident to a search warrant when those individuals have left the premises before the search warrant could be executed. Police detained Chunon Bailey a mile away from his home, incident to a search warrant of his home. Bailey claims his Fourth Amendment [text] rights were violated, with his attorney arguing, "[b]ecause individuals who have left the scene do not pose an immediate threat to the safe and efficient completion of the search, the court of appeals erred by permitting their detention absent probable cause or even individualized suspicion," citing Michigan v. Summers [text]. The Solicitor General denied this understanding of Summers: "So let me be very clear. In the government's view, Summers is about current and recent occupants, people whom police, when they are executing the warrant, find at the home or see leaving the home in the process of executing a warrant. And the question here is do the justifications apply equally as a departing occupant steps away from the home and onto a sidewalk, a yard, a couple blocks away. And I think my friend's answer to that has a wonderfully abstract quality to it that doesn't engage any of the realities on the ground. [...] The justifications for detention apply equally to departing occupants when they are seen by officers leaving in the process of executing the warrant. [...] [T]he government is not contending that other connections to the residence, other than that kind of observed connection by the officers, could justify a detention under Summers."


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