1. Using the readings, discuss the impact of Federal and State legal trends on our healthcare system. What is the impact of these same legal trends for you as a consumer of healthcare? https://attorne

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1. Using the readings, discuss the impact of Federal and State legal trends on our healthcare system. What is the impact of these same legal trends for you as a consumer of healthcare?

This article discusses the States vs the Feds regarding the Affordable Care Act (ACA)

https://www.foley.com/en/insights/publications/2018/08/the-association-health-plan-challenge-the-states-i

This article is from early 2019 summarizing cases submitted under the False Claims Act (FCA),

https://bbhosted.cuny.edu/bbcswebdav/pid-59521337-dt-content-rid-462116808_1/xid-462116808_1

2. Review the attached article on the Affordable Care Act and the case studies for the four reviewed states.  Provide a short synopsis of each State’s program as well as a summary of the article.

1. Using the readings, discuss the impact of Federal and State legal trends on our healthcare system. What is the impact of these same legal trends for you as a consumer of healthcare? https://attorne
Artic le B y Kevin M . M cG in ty Min tz Healt h C are A dvis o ry Healt h L a w & M ana ged C are All F e dera l H ealt h C are E n fo rc e m en t Y ear in R evie w & 2 01 9 O utlo ok: A naly sis o f H ealt h C are F C A L it ig atio n T re n ds W edne sd ay, Ja nua ry 9 , 2 0 19 In 2 0 18 , t h e v o lu m e o f F a ls e C la im s A ct ( F C A) lit ig atio n r e m ain e d h ig h, a nd h e alt h c a re – re la te d qui t a m (i.e ., w his tle blo w er) c a se s c o ntin ue d t o le ad t h e w ay. U sin g d ata c o m pile d in t h e M in tz H ealt h C are Q ui T a m D ata base ( w hic h is d escrib ed fu rth e r b elo w ), t h is p ost ana ly ze s t h e t re nd s in c a se s u nse ale d in 2 0 18 . T o e va lu a te lo ng -te rm t re nd s, w e e xa m in e d th e annua l D epartm ent o f Ju stic e ( D O J) c o m pila tio n o f F C A c a se s . T o geth e r t h e se d ata s e ts sho w t h a t h e alt h c a re c a se s c o ntin ue t o m ake u p a la rg e m ajo rit y o f a ll w his tle blo w er ca se s b ro ug ht u nd er t h e F C A, a nd a lm ost t w o-th ir d s o f t h o se c a se s w ere b ro ug ht b y curre nt o r fo rm er e m plo ye es, m ostly a gain st la rg e p ha rm ace utic a l c o m panie s, p hysic ia ns, and h o sp it a ls . R ece nt T re nds C aptu re d in t h e M in tz H ealt h C are Q ui T am D ata base s M in tz u se s it s H ealt h C are Q ui T a m D ata base t o t ra ck a ctiv it y in u nse ale d F C A c a se s t o se e w ha t t y p es o f c a se s a re b ein g b ro ug ht, w ho is b ein g t a rg ete d, a nd w ho is b rin g in g th o se c a se s. H ere a re s o m e h ig hlig hts fr o m t h e t w elv e m onth s e nd ed N ove m ber 3 0 , 2 0 18 . W e a ls o r e port o n qui t a m c a se d eve lo pm ents p erio dic a lly t h ro ug h o ur Q ui T a m U pdate . T re nd # 1: P harm ace utic a l C om pan ie s, P hysic ia n s, H osp it a ls , a n d H om e H ealt h C are C om pan ie s W ere t h e L e ad in g T arg ets o f U nse ale d C ase s in 2 018 The im porta nce o f d ru g t h e ra pie s in m odern h e alt h c a re is r e fle cte d in t h e h ig h v o lu m e o f FC A lit ig atio n a gain st p ha rm ace utic a l c o m panie s. A s s ho w n in T a ble 1 b elo w , pha rm ace utic a l a nd b io te ch c o m panie s w ere , b y a la rg e m arg in , t h e m ost c o m monly ta rg ete d d efe nd ant t y p e in F C A c a se s u nse ale d in 2 0 18 . [ p ag e] Sourc e : M in tz Q ui T a m D ata base The c a se s u nse ale d a gain st d ru g c o m panie s in 2 0 18 t y p ic a lly fo cuse d o n a lle gedly im pro per m ark e tin g p ra ctic e s, s uch a s im pro per in d uce m ents o ffe re d o r g iv e n t o p re scrib ers , a s w ell a s o ff- la bel m ark e tin g o f p re scrip tio n d ru g s. T he v o lu m e o f p ha rm ace utic a l- re la te d lit ig atio n is p re sum ably a fu nctio n o f t h e la rg e v o lu m e o f d ru g r e im burs e m ents u nd er M edic a re a nd M edic a id , w hic h is a rg ua bly t h e c a se w it h re sp ect t o h o sp it a ls a nd p hysic ia ns a s w ell. T he g ro w in g im porta nce o f h o m e h e alt h a nd h o sp ic e c a re is r e fle cte d in t h e fa ct t h a t, fo r a se co nd y e ar in a r o w , t h a t s e cto r r a nke d fo urth in t e rm s o f t h e n um ber o f c a se s u nse ale d. G iv e n t h e o ng oin g g ro w th o f t h e e ld erly p opula tio n in t h e U nit e d S ta te s, s uch c a se s a re lik e ly t o c o ntin ue t o c o nstit u te a le adin g c a te gory fo r u nse ale d F C A c a se s. T re nd # 2: G ove rn m ent In te rv e ntio n R ate s R em ain L o w Sin ce 2 0 12, w he n M in tz b egan t ra ckin g h e alt h c a re qui t a m lit ig atio n, g ove rn m ent in te rv e ntio n r a te s h a ve c o nsis te ntly r u n a t a bout 2 0 % . A s sho w n in T a ble 2 , t h a t t re nd c o ntin ue d in 2 0 18 . [ p ag e] Sourc e : M in tz Q ui Ta m D ata base As t h is c ha rt s ho w s, t h e gove rn m ent o utrig ht declin e d 2 0 2 o ut o f 2 6 4 unse ale d c a se s, a declin a tio n r a te o f 7 7% . The g ove rn m ent in te rv e ne d in w ho le o r in part in 4 5 o f t h e 2 6 4 ca se s, a n in te rv e ntio n ra te o f 1 7 % . ( T he bala nce o f t h e u nse ale d ca se s d id n o t d is clo se t h e gove rn m ent’s in te rv e ntio n decis io n). A cco rd in g t o th is d ata , t h e g ro w in g vo lu m e o f h e alt h c a re re la te d qui t a m lit ig atio n ha s n o t in cre ase d t h e gove rn m ent’s in te rv e ntio n ra te . Tre nd # 3: C urre nt an d F orm er Em plo ye es a re M ost Com mon Whis tle blo w ers In c a se s u nse ale d in 2 0 18 , fo rm er e m plo ye es w ere ove rw he lm in g ly t h e m ost co m mon t y p e o f r e la to r, as s ho w in T a ble 3 b elo w , m akin g u p a lm ost h a lf o f a ll r e la to rs in t h e t w elv e m onth s e nd ed N ove m ber 3 0 , 2 0 18 . Sourc e : M in tz Q ui T a m Data base To geth e r, c urre nt a nd fo rm er e m plo ye es m ade u p 63% o f a ll r e la to rs d urin g th a t p erio d, c o ntin uin g t h e tre nd t h a t in sid ers r e m ain th e m ost c o m mon s o urc e o f whis tle blo w er c a se s. T he num ber o f c o ntra cto rs a nd co nsult a nts b rin g in g qui ta m c a se s h a s g ro w n o ve r tim e, b ut t h o se c a te gorie s re m ain q uit e s m all in co m paris o n t o c urre nt a nd fo rm er e m plo ye es. Lo ng-T erm T re nds Captu re d in D O J D ata Thre e y e ars a go we pub lis he d a p ie ce exa m in in g qui t a m lit ig atio n tre nd s b ase d o n Departm ent o f Ju stic e d ata . Arm ed w it h d ata fo r t h e ensuin g y e ars , in clu d in g th e re ce ntly r e le ase d d ata fo r 2 0 18 , w e c o ntin ue t o exa m in e t re nd s in t h is sp ace . T he fo llo w in g a re so m e h ig hlig hts fr o m t h e most r e ce nt D O J d ata . Tre nd # 4: Q ui T am Actio ns C ontin ue t o D om in ate F CA c a se s, E sp ecia lly in H ealt h C are In 2 0 15, o ur a na ly sis c o nfir m ed t h a t t h e g ro w th in F C A lit ig atio n o ve r t h e p re ce din g t w enty y e ars h a d p re dom in a ntly b een d ue t o c a se s b ro ug ht by p riv a te p artie s ( i.e ., w his tle blo w ers ) r a th e r t h a n t h e g ove rn m ent. T his t re nd h a s c o ntin ue d in t h e in te rv e nin g y e ars . T he c ha rts b elo w dem onstra te t h a t t h e t o ta l n um ber o f F C A c a se s is d riv e n la rg ely b y t h e n um ber o f qui t a m c a se s. F o r e xa m ple , a s T a ble 4 illu stra te s, t h e vo lu m e o f g ove rn m ent-in stit u te d c a se s h a s r e m ain e d la rg ely u ncha ng ed s in ce t h e la te 1 9 90s w hile t h e v o lu m e o f qui t a m c a se s h a s [ p ag e] skyro cke te d, le adin g t o o ve ra ll g ro w th in F C A lit ig atio n. Sourc e : D O J F C A D ata fo r F Y20 18 Tha t s a m e t re nd is illu stra te d in b ar c ha rt fo rm in T a ble 5 , w hic h s ho w s t h a t a s t h e o ve ra ll n um ber o f c a se s c o ntin ue s t o c lim b, t h e g ro w th co nsis ts a lm ost e ntir e ly o f w his tle blo w er c a se s. Sourc e : D O J F C A D ata fo r F Y20 18 The d ata a ls o illu stra te t h a t h e alt h c a re -re la te d c a se s ( c a te goriz e d b y t h e D O J a s “ H HS c a se s”) c o ntin ue t o d om in a te F C A c a se s. Ju st a s qui ta m lit ig atio n g ro w th h a s d riv e n in cre ase s in o ve ra ll F C A lit ig atio n, t h e d ata in T a ble 6 s ho w t h a t g ro w th in h e alt h c a re -re la te d c a se s h a s fu e le d t h a t t re nd . [ p ag e] Sourc e : D O J F C A D ata fo r F Y20 18 And , a s w e fo und w it h F C A c a se s o ve ra ll, t h e v a st m ajo rit y o f H HS c a se s c o ntin ue t o b e b ro ug ht b y p riv a te in d iv id ua ls . A s s ho w n in T a ble 7 , ove r e ach o f t h e p ast t w enty y e ars , t h e p erc e nta ge o f h e alt h c a re -re la te d F C A c a se s in stit u te d a s p riv a te ly file d qui t a m c a se s h a s r a ng ed betw een s e ve nty -n in e a nd n in e ty -fiv e p erc e nt. [ p ag e] Sourc e : D O J F C A D ata fo r F Y20 18 T re nd # 5: T ota l S ettle m ents a n d Ju dgm ents D eclin e, b ut H ealt h C are R eco ve rie s T re nd U pw ard Sin ce 2 0 14 , w e h a ve s e en a d eclin e in t h e t o ta l d olla rs r e co ve re d u nd er t h e F C A. A s s ho w n in T a ble 8 , t o ta l r e co ve rie s h a ve fa lle n fr o m a h ig h of $ 6.1 b illio n in 2 0 14 t o $ 2.8 b illio n in 2 0 18 , t h e s m alle st a nnua l r e co ve ry s in ce t h e $ 2.5 b illio n r e co ve re d in 2 0 09. Sourc e : D O J F C A D ata fo r F Y20 18 [ p ag e] This d ro p in t o ta l r e co ve rie s a ppears t o b e d ue m ostly t o a 8 8% d ro p in t h e n um ber o f “ O th e r” F C A c a se s o ve r t h e la st t h re e y e ars ( i.e ., ca se s t h a t fa ll o uts id e o f t h e H HS a nd D oD c a te gorie s), a s illu stra te d in T a ble 9 . Sourc e : D O J F C A D ata fo r F Y20 18 W hile h e alt h c a re -re la te d r e co ve rie s a ppear t o h a ve t ic ke d u p w ard in 2 0 18 , t h a t in cre ase m ay b e d ue , in p art, t o t h e g ove rn m ent’s c re ativ e acco untin g , in w hic h it in clu d ed in t h e F Y 2 0 18 fig ure s t w o la rg e s e ttle m ents a nno unce d o n O cto ber 1 , 2 0 18 , w hic h is t e chnic a lly in F Y 2 0 19 . Ta ble 1 0 illu stra te s t h a t, w it h t h e e xce ptio n o f 2 0 06, t h e la st t w enty y e ars h a ve s e en qui t a m c a se s d riv e t h e r e co ve re d d olla rs . Sourc e : D O J F C A D ata fo r F Y20 18 Giv e n t h e p re pond era nce of qui t a m la w suit s in o ve ra ll FC A lit ig atio n, t h is t re nd w ill pre sum ably c o ntin ue b eyo nd 20 18 . ©19 94-2 0 19 M in tz , L e vin , Cohn, F e rris , G lo vsky a nd Popeo, P .C . A ll R ig hts Rese rv e d. Sourc e U RL: http s:/ /w ww.n a tla w re vie w .c o m /a rtic le /h e alt h -c a re -e nfo rc e m ent-y e ar-re vie w -2 0 19 -o utlo ok-a na ly sis -h e alt h -c a re -fc a -lit ig atio n [ p ag e]

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