Duquesne Law Review


Reed Hamilton


In 1983, the nature of health care delivery in this country was fundamentally altered with the enactment of the Medicare Prospective Payment System (PPS). This revolutionary change in reimbursement policy has altered the entire system of financial incentives through which hospitals have provided services to Medicare recipients. In order to effectively respond to PPS, hospitals have been forced to diversify their product lines and to develop new relationships with physicians. Often, however, as the author points out, these countermeasures have been frustrated by the formidable barriers of the Certificate of Need program and the Medicare and Medicaid fraud and abuse restrictions. After examining each of these barriers and offering practical guidance, the author concludes that ultimate relief must take the form of legislative action.

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