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House Passes FDA User Fee Bill; Congress on Track to Pass Reconciled Bill by Beginning of July Print E-mail
Written by   
Thursday, 21 June 2012 00:00

On May 30, 2012, the U.S. House of Representatives passed the Food and Drug Administration Reform Act of 2012-the chamber's FDA user fee authorization bill-by a 387-5 margin. With regard to user fees, the bill is very similar to the Food and Drug Administration Safety and Innovation Act (S. 3187), which was approved by the Senate a few days earlier, on May 24, 2012. However, there are substantive differences between the House and Senate bills with regard to provisions that address the FDA's review and oversight of drugs, medical devices and biologicals. In this newsletter, we provide an overview of some of the major aspects of both bills, and identify similarities and differences between the two pieces of legislation as the two chambers enter the reconciliation process to finalize the legislation for presentation to President Obama.

Read the full article here.
What Are Your Chances of Being Audited By the IRS? Print E-mail
Written by Jeffrey B. Kramer, CPA   
Friday, 15 June 2012 00:00

The Internal Revenue Service (IRS) has issued its annual Data Book which provides statistical data on its fiscal year 2011 activities.

Of the 140,837,499 individual income tax returns filed during fiscal year ended 2011, 1,564,690 (or 1%) were audited, which is roughly the same percentage as the prior year.

Of those audited, 31% were for tax returns that claimed the earned income tax audit (EITC) which is available to low-income individuals with qualifying children.

Examination rates go up as income increases as shown in the following table:

% Being                                                   Income
Audited                                                    Level              

  1.0%                                                       $100,000 - $200,000

  2.7%                                                       $200,000 - $500,000

 11.8%                                                      $1,000,000 - $5,000,000

Roughly 25% of the IRS audits were conducted in person by revenue agents, tax compliance officers, tax examiners and revenue office examiners. The remaining 75% of the audits were conducted via correspondence letters.

During fiscal year 2011, the IRS assessed 28.75 million civil penalties against individual taxpayers. Of those, 58.6% received "failure to pay" penalties, 25.6% received "underpayment of tax" penalties and 13% received "filing delinquency" penalties.

The IRS initiated 4,720 criminal investigations in 2011. Of those, 3,410 resulted in referrals for prosecution with 2,350 convictions. Of those sentenced, 82% were incarcerated.

The take away from this data is that low income tax payers claiming the EITC and high earners with income exceeding $1,000,000 are most likely to be audited. Of those being audited, most will be conducted via correspondence letter audits. Very few audits result in criminal investigations; however, once an investigation is initiated, 69% result in convictions.

To contact the author, click Jeffrey B. Kramer, CPA

Last Updated on Sunday, 17 June 2012 16:57
Four Healthcare Stocks Make 2011 Top 20 List Print E-mail
Written by Jeffrey Herschler   
Thursday, 14 June 2012 00:00

Fortune magazine recently released its Top 20 Best Performing S&P 500 Stocks of 2011. Four healthcare companies made the list: 
  • WellCare #2
  • Biogen Idec #4
  • Humana #7
  • Rite Aid #20

With a whopping 73.7% total return to shareholders last year, the editors had this to say about WellCare's startling reversal of, no pun intended, fortune:

"It was only a few years ago that this Tampa-based health company struggled amid Medicaid-fraud probes and shareholder lawsuits, which subsequently led to a management shake-up. The insurer began improving its bottom line during the second half of 2010 and continued to do so in 2011.

WellCare, which provides managed care plans for Medicare and Medicaid, reported strong earnings as membership rebounded after declining in 2010. This was largely driven by the growth in its Medicare prescription drug programs. Like other health insurers, WellCare also benefitted as Americans used fewer medical services, which in turn has helped drive down the portion of premiums used to cover medical costs."

Last Updated on Friday, 15 June 2012 11:20
Bad News, Good News: Total Healthcare Costs for American Family Exceeds $20k, Rate of Cost Growth Slows Print E-mail
Written by Jeffrey M. Herschler   
Sunday, 10 June 2012 00:00

 According to the recently published Milliman Medical Index 2012, the average American family's annual healthcare expenditures will exceed $20,000 (roughly the cost of a basic, mid-size sedan) for the first time. This figure represent the total cost of healthcare for a family of four covered by an employer sponsored Preferred Provider Plan (PPO). This is a 6.9% increase over last year. The rate of increase fell below 7% for the first time. Of the cities studied, Miami was the most expensive with an average annual figure of $24,965. New York, Chicago, Boston and Philadelphia rounded out the top five most expensive cities. Meanwhile the least expensive cities were Denver, Dallas, Seattle, Atlanta and Phoenix. Employers continue to shoulder the larger portion of total cost (58%). That said the study's authors are quick to point out that the employer piece of the payment is part of the employee's total compensation. Thus, in reality, the employee is burdened with the entire cost of healthcare since his/her salary would be higher without the benefit.

With the Supreme Court decision looming, one very significant section of the report addresses Healthcare Reform (the Patient Protection and Affordable Care Act) and its impact on cost. Examining several different scenarios (PPACA fully intact, PPACA without the Individual Mandate and no PPACA), the report forecasts effects on consumers, employers, the government and providers. The authors conclude, somewhat ominously, "While several aspects of healthcare reform would have meaningful impact on the cost of insurance coverage, the effect on total cost of care is very limited for our family of four." With regard to providers, the authors state "the pressure to lower healthcare costs, including a focus on provider reimbursement, coordination of care, and narrower networks, will not go away" regardless of PPACA's fate.

Milliman is among the world's largest independent actuarial and consulting firms, with revenues of $723 million in 2011. Founded in Seattle in 1947, the firm currently has 55 offices in key locations worldwide. Milliman has published the index since 2001. To view the entire report, click HERE. To view a related article from the New York Times, click HERE.

Last Updated on Monday, 11 June 2012 10:19
Super Group Doctors Beware of Departure Provisions Print E-mail
Written by Jeffrey Cohen   
Sunday, 03 June 2012 00:00

Super groups are in vogue as physicians do their best to reduce costs and enhance revenues. A "super group" is essentially a collection of previously separate competitors who have joined a single legal entity in order to achieve certain advantages. Those advantages tend to be (1) reducing overhead expense associated with economies of scale. Buying insurance for a group of 100 doctors should be far less expensive per doctor than a group of three doctors; (2) gaining leverage in managed care contracting. 20 groups of five physicians each cannot contract with a payer with "one voice" due to the antitrust restrictions, but a single group of 100 doctors can; and (3) finding new revenue sources. Small groups and solo practices cannot afford revenue producing services like surgery centers, imaging services and such. When practices combine, they have a greater patient base, which makes the development of new revenue sources feasible.

Physicians join super groups with terrific promise and hope. They are clearly a good idea, especially if they have solid operations. That said, physicians who rush to form them rarely consider the risks associated with a physician departing the group. They need to!

When a doctor joins a super group, she stops billing through her old practice (the "P.A.") and starts billing through a new group (the "LLC"). The LLC has a tax ID number and a Medicare group number. And the LLC enters into lots of managed care payer agreements. Simply put, the doctor puts all of her eggs in the LLC basket.   So what's the risk?

When physicians depart super groups, they have to confront difficult facts, like:

It will take months to get a new Medicare provider number. If they haven't billed through their "old entity" for a while, that number is gone. And getting a new number for the departing physician takes time, during which revenues associated with Medicare patients are lost (until the number is obtained);

It takes even longer to get on insurance plans. If the LLC is contracted (they usually are), how long will it take to get the P.A. fired back up? It can take as long as six months (and sometimes even more). That means the departed doctor is out of network with all the plans! This exposes her patients to higher costs and may affect referral patterns. This alone can be crippling to a physician who has left the super group.

Leaving can also mean ending access to patient scheduling and electronic medical records. Many super groups do not ensure access to patient scheduling or billing to enable a departing physician to get back on their feet; and this can be devastating.

Noncompetes can play a big role in how a departing physician resumes her income stream. Ideally she will know that being solo is not as good as being part of a larger practice. But what if the super group imposes a restriction on the departing physician that prevents her from being part of another group? This is common and often very harmful, since some physicians who depart super groups have no effective options but to join other groups.

Super groups exist to benefit physicians. It makes no sense that they would be used to harm them, which is precisely what can happen (and sometimes does happen) if physicians do not pay good attention to the "back end" as well as they do to the "front."  Super group arrangements continue to grow. Some of them even develop into fully integrated and sophisticated businesses. Physicians who join them have to consider all "angles," not just how good it will be or can be when they join.

With almost 25 years of healthcare law experience following his experience as legal counsel for the Florida Medical Association, Mr. Cohen is board certified by The Florida Bar as a specialist in healthcare law. With a strong background and expertise in transactional healthcare and corporate matters, particularly as they relate to physicians, Mr. Cohen's practice involves him in regulatory, contract, corporate, compliance and other healthcare law related matters. As Founder of the Florida Healthcare Law Firm, Mr. Cohen can be reached at 888-455-7702 or online at: 

Last Updated on Monday, 04 June 2012 08:05
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