Reproduced with permission from BNA's Health Care Daily Report,(July 20, 2010). Copyright 2010 by The Bureau of National Affairs, Inc. (800-372-1033) http://www.bna.com

The Centers for Medicare & Medicaid Services should implement a two-track review process for provider disclosures of physician self-referral violations, creating an expedited review process for noncomplex issues and providing for detailed reviews in more complicated situations, according to a letter from the American Hospital Association to Department of Health and Human Services Secretary Kathleen Sebelius.

“Creating an expedited process recognizes that many actual or potential violations do not involve a complex set of facts, while detailed review would be used when the circumstances require a more involved description or analysis,” the July 16 letter from Rick Pollack, executive vice president of AHA, said.

Section 6409 of the Patient Protection and Affordable Care Act (PPACA, Pub. L. No 111-148) requires the secretary of health and human services to create a self-referral disclosure protocol through which providers can disclose actual or potential violations of the physician self-referral act (Stark law).

A two-track review process would reduce administrative burdens on both CMS and providers by providing for the quick resolution of low-risk violations, the letter said, while still retaining the ability to engage in detailed reviews when appropriate.

“The AHA does not want the two-track process to be so defined as to limit its utility and the ability of CMS to address complex situations that must be evaluated on a case-by-case basis, so a desk review would be a key first step to the process,” Jana Kolarik Anderson, an attorney with Nelson Mullins Riley & Scarborough, told BNA July 19.

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