The Largest Takedown in Medicare Strike Force History and Your Health Care Practice: The Next Layer of Compliance Guidance

Posted on September 20, 2010 by Ilana Sable

 

In the largest federal health care takedown in the history of the Medicare Fraud Strike Force, ninety-four people throughout Baton Rouge, Brooklyn, Detroit, Houston and Miami were charged for their alleged participation in schemes to collectively submit more than $251 million in false claims to the Medicare program

The charges stemmed from various Medicare fraud-related offenses, including conspiracy to defraud the Medicare program, criminal false claims, violations of the anti-kickback statute and money laundering. The false claims identified and targeted by the Medicare Fraud Strike Force directly mirror the “issues under review” identified by Medicare’s Recovery Audit Contractors (“RACs”), including the RAC for Region A (covering New York and New Jersey). Practices looking to identify procedures and/or services that are being targeted by auditors, investigators and/or reviewers should see the issues under review for their regional RAC and, in particular, the targeted abuse discussed by the RAC.

In this historic takedown, the Medicare Strike Force identified participation in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes never provided for the following procedures and/or services:

  • physical therapy and occupational therapy schemes
  • home health care services
  • HIV infusion fraud
  • Durable Medical Equipment (DME)
  • Nerve conduction tests
  • IV infusion therapy

 

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Electronic Health Records and the Medicare / Medicaid Incentive Program: Five Reasons to Hold Off on Purchasing an Electronic Health Records Product

Posted on September 7, 2010 by Ilana Sable

 

If your health care practice has not yet purchased and/or converted to an Electronic Health Records (“EHR”) product, there are, at minimum, five reasons why your practice should consider holding off on making the purchase for a few more months. 

  1. To date, no EHR product has been certified as capable of meeting the criteria to support “meaningful use and quality eligible providers and hospitals” for funding under the American Recovery and Reinvestment Act (“ARRA”). In fact, it was only on August 30, 2010 that the Office of the National Coordinator for Health Information Technology announced that it had approved two organizations – CCHIT and The Drummond Group - to act as Authorized Testing and Certification Bodies (“authorized body”) to begin certifying EHR products. Eligible professionals, hospitals and critical access hospitals participating in the incentive program must use an EHR product certified by an authorized body to receive benefits.
  2. Providers hoping to participate under the Medicaid Incentive Program will not have complete “meaningful use” criteria until (and unless) each individual State launches its additional requirements for meaningful use. States choosing to launch a Medicaid Incentive Program will do so beginning in January, 2011. In doing so, each State will be required to identify four (4) additional core “meaningful use” objectives for their Medicaid providers. Until each State has identified its individual core objectives, Medicaid providers have no way of knowing whether, and with what functionality, an EHR product can fulfill the practices specific EHR needs.
  3. Most EHR products will require upgrades and/or additions before becoming certified EHR products. Most EHR products on the market today will need to (a) be upgraded and/or (b) add new functionality to meet the criteria of a certified EHR product. For instance, CCHIT certified less than thirty EHR products - there exist three hundred+ vendors on the market today - as meeting “Preliminary ARRA” requirements (“Preliminary ARRA” certification was given to EHR products that were tested against and met the published certification criteria and standards in the HHS Interim Final Rule of January 13, 2010).
  4. Registration for the EHR Incentive Programs does not begin until January, 2011.  Providers will not be able to register for an EHR incentive program until January, 2011 and attestation for the Medicare Incentive Program will not begin until April, 2011. Accordingly, while early use of an EHR product may have distinct and undisputable benefit to any health care practice, in terms of the incentive programs there is no immediate need to commit to any one product until data on certified EHR technology is available.
  5.  Multiple demonstrations and training are critical to making an informed decision. Providers are encouraged to begin conducting their search for an EHR product early on and to audit as many products as possible.  Moreover, once a practice has narrowed its EHR search down to a particular product, it is encouraged to participate in multiple demonstrations and to include its key employees (i.e. medical billers and coders, compliance officers, nurses and intake personnel) for individual feedback and criticism. Keep in mind that demonstrations by sales representatives and individual software testing can take a few hours each time so the sooner providers begin researching and testing these EHR products, the easier it will be to make an informed decision when the time to purchase an EHR product comes.

 

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