AMA Offers Physicians Help Claiming Damages From UnitedHealth Settlement

The American Medical Association (AMA) today launched a new online resource that will help thousands of physicians file claims in the record-breaking settlement reached in the AMA legal victory against UnitedHealth Group—the nation’s largest health insurer. More than $350 million is available to compensate physicians and their patients for 15 years of artificially low payments for out-of-network services.

The UnitedHealth settlement is governed by a series of court-imposed deadlines that physicians must follow. The current settlement deadlines include the following key dates:

July 27 – Deadline for filing objections to the settlement or for opting out of the settlement.

September 13 – Date for the final settlement hearing to consider any filed objections.

October 5 – Deadline for filing a claim to share in the settlement fund.

AMA Morning Rounds: Some patients feel betrayed by Genzyme over drug shortage.

On the front page of its Business Day section, the New York Times (4/16, B1, Pollack) reports that thousands of people "have been hard hit by a shortage of drugs made by the biotechnology company Genzyme to treat two rare inherited" conditions, Fabry disease and Pompe disease. As a result, "the close relationship -- unusual in the pharmaceutical industry -- that Genzyme had carefully built with the several thousand users of its high-price medicines" has "frayed." In fact, "some of those patients now say they feel betrayed by the company they once viewed as their savior." The company, "which initially predicted that the drug shortages would last six to eight weeks, has repeatedly backtracked on when supplies would be fully restored, as it has run into further manufacturing problems."

Medicare Cuts Delayed Until June 1

Last night, the President signed H.R. 4851, the Continuing Extension Act of 2010, into law, reinstating Medicare physician payments to where they were on March 31 and again postponing the 21.3 percent cut that was supposed to take effect in 2010. This most recent extension of 2009 payment rates will continue through the end of May, and will be applied retroactively to all physician services provided to Medicare patients in April.

Yesterday, the hold on processing April claims that the CMS had placed to avoid implementing the payment cut technically expired. However, with Congressional action so imminent, do not believe many claims were actually processed at the lower payment rates. However, CMS indicated that any claims paid that reflected the 21.3 percent cut will be reprocessed automatically without any action required from physicians.

Senate Advances Delay of Medicare Cuts

Yesterday the Senate voted 60-34 to limit debate on a bill that extends a number of expiring programs, including a dealy of the 21% Medicare physician payment cut. No deal has been struck to expedite passage of the bill. Without such an agreement, Senate procedures do not allow for a final vote until later in the week.

CMS instructed its carriers to refrain from processing any claims for services provided on or after April 1 for 10 working days, to minimize administrative complications and other disruptions that would result from calculating payments that reflect a rate reduction that Congress is expected to overturn. That 10 day grace period expires on Wednesday, April 14. If Congress fails to pass legislation by close of business on Wednesday, Medicare law will require carriers to begin processing claims for services provided in April with the 21 percent cut. However, it is expected Congress will to pass legislation that retroactively restores payments to levels in place prior to April 1.

AMA Morning Rounds: Lithium may not help patients with ALS

The AP (4/6, Cheng) reports, "Lithium doesn't help patients with ALS, or Lou Gehrig's disease, contrary to previous study results, new research says." For the "first trial to scientifically assess whether lithium works for Lou Gehrig's disease, doctors found it had no effect -- and stopped the study early because it seemed futile." Eighty-four "patients with Lou Gehrig's disease" were enrolled in the study, and after "nearly six months, researchers didn't see any difference: 22 of the 40 patients in the lithium group had gotten worse versus 20 of 44 patients in the placebo group." The Los Angeles Times (4/5, Maugh) "Booster Shots" blog and MedPage Today (4/5, Gever) also covered the story.