Thousands of physicians across the country are involved in class-action lawsuits alleging that the nation’s largest insurers are involved in a “conspiracy … to deny, delay and diminish payments to health care providers.” [1] According to the Heritage Foundation, the denial rate for Medicaid is three times that of private insurance companies, and the lag time between the date of service and the date of payment is twice as long.[2] Collecting payments from insurance companies and Medicaid can be a nightmare for healthcare providers, and it is only going to become more difficult.

Under the Patient Protection and Affordable Care Act, Medicaid will cover eighteen (18) million new patients, and if procuring payment from the government caused a headache before, those eighteen (18) million new patients are not all that the Act offers health care providers. Physicians can now look forward to more governmental regulations, red tape, and bureaucracy, which will further impede claims and payment process. The Act creates over one hundred fifty (150) new boards, commissions, and programs to decide what benefits insurance companies must offer, to whom they must be offered, and what they must charge for those benefits. The new bureaucracies will also determine what insurance coverage employers and individuals must purchase and at what cost , what is considered quality care and what is not, and what services doctors will be paid for and when.

Section 3403 of the Act creates an Independent Payment Advisory Board. The Board will consist of fifteen (15) members, appointed by the President, and its job will be to decide the fair market value of physicians’ services.  According to Dr. Jeffrey B. English, a government board cannot decide the fair market value of a service, “they will make decisions based on politics and undoubtedly will underpay physicians.” [3] The Board’s goal is to reduce the per capita growth rate in Medicare spending, and make recommendations for slowing growth in non-federal health programs. [4] In other words, the Board will make recommendations for reducing spending, i.e. cutting payments to physicians.

In 2008, more than fifty-four percent (54%) of doctors surveyed by the Physicians Foundation rated reimbursement issues as “most unsatisfying”.[5] The result of removing free market principles from the health care system and adding hundreds of bureaucracies, under which it must now function, can only be lower physician payments, slower payment schedules, and higher denial rates. As it is, doctors must haggle with insurance companies to procure insufficient payment for their services and the Patient Protection and Affordable Care Act will only make the claims process more difficult to navigate.

Special thanks to Shelley Riseden for her help on this piece.

The Agresta Firm’s health law practice is experienced and ready to handle your medical claims.  Please contact us for more information about how the Patient Protection and Affordable Care Act can help you.

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[1] Los Angeles Times, The Battle over Bills, 2008

[2] Heritage Foundation, Obamacare and Medicaid: Expanding a Broken Entitlement and Busting State Budgets, 2011

[3] Dr. Jeffrey B. English, Obamacare 2010: Politicians Want A “Good Story”, Basil & Spice, 2010

[4] Physicians News Digest, Obamacare and Its Impact on Doctors, 2010

[5] Heritage Foundation, Obamacare and Medicaid: Expanding a Broken Entitlement and Busting State Budgets, 2011

The Act applies to any institution whose business is to engage in financial activities. It defines “financial activities”, in part, as “arranging, effecting, or facilitating financial transactions for the account of third parties.” Because one of the primary activities of an auto dealership is to arrange for banks and/or credit unions to provide loans to its customers, an auto dealership is considered to be in the business of engaging in financial activities, and therefore a financial institution for the purpose of the Gramm-Leach-Bliley Act. As an entity covered by the Act, an auto dealership is required to provide its customers with an explanation of what information may be disclosed to a third party, whom that third party may be, and to provide an explanation of how the customer may exercise the option of directing that their information not be disclosed. The dealership must provide this information to its customers before any disclosure is made.

The Act applies to nonpublic personal information, which is defined as “personally identifiable financial information” disclosed to the institution or obtained by it in the course of any transaction between the institution and the consumer or any service provided to the consumer. Such personally identifiable information is commonly requested during the discovery phase of litigation. The Gramm-Leach-Bliley Act permits auto dealers to redact personal identifiers from responses to discovery requests in order to ensure compliance with section 6802(b)(1). This section would require that, before answering discovery requests, a dealer contact all consumers whose information is being requested, inform them of the information requested, advise them as to the name of the third party requesting the information, and provide them with an option for directing that the information not be disclosed.  Since answers to discovery requests are generally due within thirty (30) days, the only way to comply with section 6802(b)(1) of the Gramm-Leach-Bliley Act and return discovery responses in a timely manner is to redact all personally identifiable information from the responses.

Recognition of the importance of financial privacy is enshrined in public policy and codified in the Gramm-Leach-Bliley Act. The discovery process may not be used in order to circumvent the Act and the redaction of personally identifiable information from discovery requests is permitted by operation of the Act.

Special thanks to Shelley Riseden for her help on this piece.

The Agresta Firm’s dealer law practice is experienced and ready to handle the demands of civil litigation for automobile dealerships.  Please contact us for more information about how the Gramm Leach Bliley Act can affect your business.

It shall now be unlawful for a motor vehicle manufacturer to:

• To impose or attempt to impose any requirement, limitation or regulation on, or interfere or attempt to interfere with, the manner in which a motor vehicle franchisee utilizes the facilities at which a motor vehicle franchise is operated, including, but not limited to, requirements, limitations or regulations as to the line makes of motor vehicles that may be sold or offered for sale at the facility, or to take or withhold or threaten to take or withhold any action, impose or threaten to impose any penalty, or deny or threaten to deny any benefit, as a result of the manner in which the motor vehicle franchisee utilizes his facilities, except that the motor vehicle franchisor may require that the portion of the facilities allocated to or used for the motor vehicle franchise meets the motor vehicle franchisor’s reasonable, written space and volume requirements as uniformly applied by the motor vehicle franchisor.  1The provisions of this subsection shall not apply if the motor vehicle franchisor and the motor vehicle franchisee voluntarily agree to the requirement and separate and valuable consideration therefor is paid.
• To impose or attempt to impose any conditions on the approval of the transfer of a motor vehicle franchise, except as provided in section 6 of P.L. 1971, c.356 (C.56:10-6).
• To take or withhold or threaten to take or withhold any action, impose or threaten to impose any penalty, or deny or threaten to deny any benefit, because the motor vehicle franchisee sold or leased a motor vehicle to a customer who exported the vehicle to a foreign country or who resold the vehicle, unless the motor vehicle franchisor can establish that the motor vehicle franchisee 1[had actual knowledge] knew or reasonably should have known1 , prior to the sale or lease, that the customer intended to export or resell the motor vehicle; provided, however, that it shall be 1[conclusively]1 presumed that the motor vehicle franchisee 1[had no such actual knowledge] did not know or should not have reasonably known that the vehicle would be exported1 if the vehicle is titled or registered in any state or the District of Columbia.
• To allocate vehicles to or evaluate the performance of a motor vehicle franchise based on, or offer any discount, incentive, bonus, program, allowance or credit that differentiates between vehicle sales by a motor vehicle franchisee within a territory or geographic area assigned to the motor vehicle franchisee and vehicle sales outside of such territory or geographic area.