In recent weeks the U.S. Supreme Court has issued two decisions of interest to the health care community, and may be of interest to EMS as well. These opinions also underscore the fact that all the “action” with respect to the law isn’t just Medicare and HIPAA; it occurs at many levels in all branches of the government.
在第一次决定中，美国最高法院召开，市政当局可以根据联邦错误索赔法（FCA）起诉。这是对EMS的重要决定，因为许多市政救护车服务已于FCA的Qui Tam（举报人）规定下起诉。2000年，最高法院裁定，该行为不“人类”，不能起诉，但在这一新案件中，叫做库克郡v。最高法院的钱德勒，第01-1572号（2003年3月10日）裁定，市政当局是FCA下的人，可以妥善起诉。
In the second decision, Kentucky Association of Health Plans, Inc. et al. v. Miller, the Supreme Court upheld a state’s “any willing provider” law. This state law prohibits HMOs from discriminating against non-contracted, out-of-network providers who are willing to accept the terms and conditions of participation in the plan. The HMOs had challenged the law, claiming that it was preempted (that is, superseded) by the Employee Retirement Income Security Act (ERISA). The Supreme Court held that the state law was not preempted by HIPAA, because it was a state law which regulates insurance, which states are permitted to do. While not all states have enacted “any willing provider” laws, those states where such laws exist can breathe a little easier knowing that these laws have survived a major challenge. These laws are a benefit to providers who are excluded from an HMO’s network but who are willing to accept the HMO’s payment for services rendered to their enrollees. It may well clear the way for other states to enact such laws that will benefit those ambulance providers who choose not to contract, but are willing to accept the HMO’s payment rates and wish to do so on a case-by-case basis instead of being obligated to what could be an onerous contract.
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