In an effort to reduce the costs of health care, President Obama issued Executive Order 13520 on November 20, 2009, with the stated goal that “every effort must be made by the Federal Government to confirm that the right provider receives the right reimbursement for the right reason at the right time.” Similarly, the Deficit Reduction Act calls for saving US$340 billion in Medicare and Medicaid spending by 2021. Such mandates have eroded the longstanding reluctance to second-guess medical decision-making by encouraging Federal agencies to investigate decisions about medical necessity.
Squire Patton Boggs partner Colin Jennings and of counsel Tom Zeno recently had an article – “Uncle Sam Becomes a Doctor” – published by the Cleveland Metropolitan Bar Association that examines how the government challenges what is medically necessary for a patient and how to protect against such challenges.
