Centers for Medicare and Medicaid Services

Internal Revenue Service Decides Electronic Health Record Incentive Payments are Taxable

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The Internal Revenue Service (IRS) has taken the position that electronic health record (EHR) incentive payments are taxable. Previously it was not specified how EHR incentive payments were to be treated or reported to the IRS. On January 14, 2013, the IRS issued guidance on this issue in a memorandum from the Office of Chief Counsel. This memorandum lists tax issues facing those who have received or who will receive EHR incentive payments. It also states the IRS’s position on those issues.

IRS Considered Three Different Issues and Gave its Stance on Each Issue.

In its memorandum, the Office of Chief Counsel considered the following three issues:

1. Whether recipients must include in gross income electronic health record
incentive payments paid by the Centers for Medicare and Medicaid Services
(CMS) pursuant to the American Recovery and Reinvestment Act (ARRA).

2. Whether CMS has a reporting requirement with regard to payments made under the EHR Incentive Program.

3. Whether the reporting requirement is altered if the payment is assigned to a third party.

The Summary of the Office of Chief Counsel’s Position on Each of the Issues.

1. The recipients must include the incentive payments in gross income unless they receive the payments as a conduit or an agent of another and are thus unable to keep the payments.

2. CMS has a reporting requirement under section 6041 of the Internal Revenue Code with respect to the eligible providers.

3. In the event of an assignment by the eligible providers to a third party, CMS would be obligated to report a payment to the eligible provider, even if the payment is assigned to a third party. The eligible provider would then likely bear a reporting obligation with respect to the assignment to a third party. CMS would not have a reporting obligation with respect to the third-party assignee unless CMS exercised managerial oversight with respect to, or had a significant economic interest in, the assignment.

Click here to read the entire memorandum.

Health Care Professionals Be Aware.

According to the IRS, taxpayers cannot avoid tax by turning over income to someone else. For example, a doctor earns an EHR incentive payment and turns it over to his/her practice. That doctor may still have to include the EHR payment on his/her personal tax return. The IRS allows an exception. If the doctor received the payment as an agent of the group practice, the doctor does not have to report it on his/her personal tax return.

Health care professionals and providers who have or will receive EHR incentive payments should plan to deal with the tax consequences of those incentives.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents physicians and medical groups on EHR problems. It also represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

As a health care professional, do you think electronic health record (EHR) incentive payments should be taxable? Please leave any thoughtful comments below.

Sources:

Goldberg, Alan. “Healthcare Reimbursement List.” American Health Lawyers Association. (April 26, 2013).

Montemurro, Michael. “Electronic Health Records Incentive Payments, POSTS-145204-12.” Internal Revenue Service. (January 14, 2013). From: http://www.thehealthlawfirm.com/uploads/1307005.pdf

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:00:48-04:00June 1, 2018|Categories: Electronic Health Record, Health Care Industry, IRS, The Health Law Firm Blog|Tags: American Recovery and Reinvestment Act of 2009 (ARRA), Centers for Medicare and Medicaid Services, CMS, defense attorney, defense lawyer, doctor, electronic health record (EHR), electronic health record incentive payments, florida attorney, Florida lawyer, health care professional, health care provider, incentive payments, Internal Revenue Service, meaningful use, Office of Chief Counsel, physician, taxable, taxes, the health law firm|Comments Off

First Year Pioneer ACO Results: Medicare Money Saved But Some Physicians Leave Program

By Lance O. Leider, J.D., The Health Law Firm

On July 16, 2013, the Centers for Medicare and Medicaid Services (CMS) issued a press release summarizing the performance results for the first year of the Pioneer Accountable Care Organization (ACO) Model. Made possible by the Patient Protection and Affordable Care Act (PPACA), the Pioneer ACO Model encourages providers and care givers to deliver more coordinated care ans services for Medicare beneficiaries. ACOs, including the Pioneer ACO Model and the Medicare Shared Savings Program, are one way CMS is providing options to providers looking to better coordinate care for patients and use health care dollars more wisely, according to CMS.

Click here to read the entire press release from CMS.

Pioneer Model ACOs Increase Quality.

The press release states that all thirty-two (32) participants in the program successfully increased the quality of care received by their beneficiaries. Consequently, each participant received incentive payments for achieving these results.

Some examples of the quality improvements were lower readmission rates and better blood pressure and cholesterol control among diabetic patients. Some examples of the quality control measures that were implemented were:

– dispatch of hospital trained nurses to beneficiaries’ homes for management of prescriptions, blood-sugar readings, healthy eating education and delivery and set up of durable medical equipment (DME); and

– care coordination by trained healthcare professionals at no cost.

Pioneer Model ACOs Increase Savings.

Of the thirty-two (32) Pioneer ACOs, thirteen (13) of them produced shared savings with CMS. This means that they exceeded the cost reduction benchmarks and were eligible to receive a percentage of those savings from CMS as compensation additional to the fee-for-service payments. In total CMS estimates that approximately $87.6 million in Medicare expenditures was saved.

However, two (2) of the Pioneer ACO participants had shared losses. This means that their per beneficiary fee-for-service expenditures exceeded the stated goal and they were required to share in the losses suffered by CMS. These losses were approximately $4 million.

Some Pioneer Model ACOs Withdrawal From Program.

Of the Pioneer ACOs that did not produce shared savings, seven (7) of them have decided to leave the Pioneer program and enroll in the standard Medicare Shared Savings Program. This program offers lower risks and lower rewards and does not have the option of moving to a capitated payment model after the first two (2) successful years.

The two (2) Pioneer ACOs that experienced shared losses with CMS have signaled their intent to withdraw from the ACO model entirely.

The First-Year Pioneer ACO Lesson: Win Some, Lose Some.

While not a total success, the Pioneer ACO program did manage to produce net savings to Medicare and improve the quality of care provided to its beneficiaries. Many news outlets who oppose PPACA are citing this as a failure of the program and yet more bad news for President Obama’s healthcare overhaul. However, many other sources share CMS’s somewhat rosier view of the program. These sources state that while the program may not have been as big a success as hoped, it was only the first year in operation and is nowhere near a failure.

According to an article in American Medical News, the American Medical Association (AMA) supports ACO programs that have allowed physicians practicing in groups of various sizes to participate in new care models. The AMA states that the first-year pioneer results are encouraging, and have the potential to improve quality and decease costs. To read the entire article from American Medical News, click here.

Data should be released on the standard Shared Savings Program ACOs in the near future.

Contact Health Law Attorneys Experienced With Healthcare Business Practices.

The Health Law Firm routinely represents physician groups and practices with issues involving establishing, licensing, selling, merging, and intergroup affiliation. If you are considering establishing an ACO or have been approached to become a participant in one, you can contact The Health Law Firm at (407) 331-6620 or (850) 439-1001 or you can visit our website at www.TheHealthLawFirm.com.

Comments?

What do you think of the performance results summery for the first year Pioneer ACO Model? What do you think about the number of groups dropping out? Please leave any thoughtful comments below.

Sources:

Centers for Medicare and Medicaid Services. “Pioneer Accountable Care Organizations Succeed in Improving Care, Lowering Costs.” CMS.gov. (July 16, 2013). From: http://cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2013-Press-Releases-Items/2013-07-16.html

Fiegl, Charles. “Medicare pioneer ACOs save money but lose physicians.” American Medical News. (July 29, 2013). From: http://www.amednews.com/article/20130729/government/130729933/1/?utm_source=nwltr&utm_medium=heds-htm&utm_campaign=20130729

About the Author: Lance O. Leider is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

MedPAC Wants to Hold Accountable Care Organizations More Accountable

By Lance O. Leider, J.D., The Health Law Firm

As the Centers for Medicare and Medicaid Services (CMS) prepares to designate the next class of accountable care organizations (ACOs), the agency sought the advice and input of the Medicare Payment Advisory Commission (MedPAC) on how to proceed. MedPAC is an independent Congressional Agency established to advise the U.S. Congress on issues affecting Medicare.

Click here to read our previous blog on the background and purpose of ACOs.

MedPAC Suggests All Medicare Shared Savings Program ACOs Join the Two-Sided Risk Model.

In response to the request from the CMS, MedPAC reiterated its previous position that it would like to see all Medicare ACOs take on greater financial risk. As it presently stands, some Medicare-contracted ACOs do not share in the risks associated with the ACOs patients’ healthcare costs exceeding certain target ranges. Even though those ACOs do not bear any financial risk if the goals are not met, they nevertheless stand to benefit if they are.

MedPAC found that the one-sided risk model being used by most Medicare Shared Savings Program (MSSP) ACOs to be insufficient to reach the goals of the MSSP.

Specifically, MedPAC wants to see all MSSP ACOs in the two-sided risk model. That model requires the ACO to reimburse Medicare for some of the costs which exceeded the target ranges. This pressure is important to note because only 13 of the 32 Pioneer ACOs generated enough savings to Medicare to qualify for MSSP savings payments.

Understand an ACO Agreement Before You Sign.

As we see more and more physicians being approached to join or form ACOs, it is crucial to understand exactly what type of arrangement you are getting into.

Many ACO contracts we see are simply for participation as a provider in the organization. However, some of the contracts we see require that the physician make a financial investment in the ACO or otherwise require that the physician pay a “pro rata” share of any penalty assessed by CMS.

Current ACO participation and recruiting is something akin to the gold rush of the nineteenth century. Everyone is rushing to stake a claim in fear of being left out. Be careful about what kind of an agreement you sign and be sure that you understand the long-term consequences of tying your practice to an as-yet unproven model. To read our previous blog on the first year pioneer ACO results, click here.

If you are approached to join an ACO, or are considering signing a participation agreement/contract with one, make sure to read the contract carefully and consult with an experienced healthcare attorney.

Contact Health Law Attorneys Experienced With Healthcare Business Practices.

The Health Law Firm routinely represents physician groups and practices with issues involving establishing, licensing, selling, merging, and intergroup affiliation. If you are considering establishing an ACO or have been approached to become a participant in one, you can contact The Health Law Firm at (407) 331-6620 or (850) 439-1001 or you can visit our website at www.TheHealthLawFirm.com.

Comments?

What do you think of MedPAC’s position on ACOs? Have you considered joining an ACO? Why or why not? Please leave any thoughtful comments below.

About the Author: Lance O. Leider is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Copying and Pasting Clinical Notes in Electronic Health Records Could Be Considered Healthcare Fraud

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The Department of Health and Human Services (HHS) Office of Inspector General (OIG) is concerned about healthcare providers carelessly copying and pasting clinical notes in electronic health records (EHRs). According to an audit report released on December 10, 2013, copying and pasting in EHRs can lead to fraudulently duplicated clinical notes, which can be considered healthcare fraud. This practice is allegedly widespread across medicine, according to a Modern Healthcare article. Federal officials say there is a need to crackdown on this behavior.

Click here to read the entire audit report from the HHS OIG.

This is the first of two reports on fraud and vulnerabilities in EHR systems. The second report from the OIG will be on weaknesses in how the Centers for Medicare and Medicaid Services’ (CMS) payment contractors monitor for fraud in EHRs. This report is scheduled to be published soon.

Report Looks at Hospital Policies Regarding Copy-and-Paste Features.

The audit report studied 864 hospitals that had received subsidies for EHR systems as of March 2012. Out of those hospitals, only twenty-four percent (24%) had any policy regarding the improper use of copying-and-pasting in EHRs. The report concluded that too few hospitals actually have policies defining the proper use of copy and paste in EHRs.

According to Modern Healthcare, adoption of EHR systems has coincided with a rapid rise in higher-cost Medicare claims. This has led to officials looking into whether EHRs are enabling illegal upcoding. Officials say that EHR features such as copy and paste make it too easy to bill for work that wasn’t actually performed and help increase reimbursements, according to Modern Healthcare. Click here to read the entire article from Modern Healthcare.

In the report the HHS OIG recommends that the CMS strengthen its efforts to develop a comprehensive plan to address fraud vulnerabilities in EHRs. It was also suggested that CMS develop guidance on the use of the copy-paste feature in EHR technology.

Tips to Help Avoid Copy-and-Paste Errors.

Tools commonly available in EHRs that allow physicians to copy and paste patient information should be used with extreme care, according to an article on American Medical News. The article offers health care providers some guidelines to help avoid errors related to copying and pasting.

– Avoid copying and pasting of text from another person’s notes.

– Avoid repetitive copying and pasting of laboratory results and radiology reports.

– Note important results with proper context, and document any resulting actions. Avoid wholesale inclusion of information readily available elsewhere in the EHR because that creates clutter and may adversely affect note readability.

– Review and update as appropriate any shared information found elsewhere in the electronic record (e.g., problems, allergies, medications) that is included in a note.

– Include previous history critical to longitudinal care in the outpatient setting, as long as it is always reviewed and updated. Copying and pasting other elements of the history, physical examination or formulations is risky, as errors in editing may jeopardize the credibility of the entire note.

Click here to read the entire article from American Medical News.

What This Means for Healthcare Providers Using EHRs.

The practice of copying and pasting previous information without checking can be considered careless and potentially dangerous to patients. It can be problematic when there are multiple teams taking care of one patient and using the chart to communicate. The right way is to make sure everything in the note you sign accurately reflects what happened on your shift.

In the report the HHS OIG stated that copy-and-paste features in EHRs will be under additional scrutiny. By knowing where the enforcement focus will be, providers can attempt to avoid copy-and-paste practices that are likely to lead to audits. Additionally, providers can beef up compliance efforts and policies.

Contact Health Law Attorneys Experienced in Handling Medicare and Medicaid Audits, Investigations and other Legal Proceedings.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

Don’t wait until it’s too late. If you are concerned of any possible violations and would like a consultation, contact a qualified health attorney familiar with medical billing and audits today. To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

In your practice do you use an EHR system? Have you had any issues with copying and pasting clinical notes? Does your practice have a copy-and-paste policy? Please leave any thoughtful comments below.|

Sources:

Carlson, Joe. “Fed Eye Crackdown on Cut-and-Paste EHR Fraud.” Modern Healthcare. (December 10, 2013). From: http://www.modernhealthcare.com/article/20131210/NEWS/312109965/cut-and-paste-function-can-invite-ehr-fraud-officials-say

O’Reilly, Kevin. “EHRs: ‘Sloppy and Paste’ Endures Despite Patient Safety Risk.” American Medical News. (February 4, 2013). From: http://www.amednews.com/article/20130204/profession/130209993/2/

Levinson, Daniel R. “Not All Recommended Fraud Safeguards Have Been Implemented in Hospital EHR Technology.” Department of Health and Humans Services Office of Inspector General. (December 2013). From: http://www.modernhealthcare.com/assets/pdf/CH92135129.PDF

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:00:53-04:00June 1, 2018|Categories: Electronic Health Record, Health Care Industry, In the Know, The Health Law Firm Blog|Tags: audit, Centers for Medicare and Medicaid Services, CMS, crackdown, cut-and-paste, defense attorney, defense lawyer, Department of Health and Human Services, duplicate clinical notes, EHR, EHR billing issues, EHR fraud, electronic health records, electronic medical records, EMR, health law firm, healthcare fraud, hhs, hospital EHR, medical billing, medicare audit, Medicare claims, Medicare fraud, Office of Inspector General, OIG, reduce fraud, reimbursements, the health law firm|Comments Off

ZPICs Seek “Voluntary” Agreements from Physicians for Auto-Denial Edits for Home Health Services

By Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law, and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

According to the Centers for Medicare and Medicaid Services (CMS), the primary purpose of Zone Program Integrity Contractors (ZPICs) is to investigate instances of suspected fraud, waste, and abuse. The specific actions employed by ZPICs to fulfil this mission include:

– Investigating potential fraud and abuse for CMS administrative action or referral to law enforcement;
– Conducting investigations in accordance with the priorities established by Center for Program Integrity’s (CPI) Fraud Prevention System;
– Performing medical review, as appropriate;
– Performing data analysis in coordination with CPI’s Fraud Prevention System;
– Identifying the need for administrative actions such as payment suspensions and prepayment or auto-denial edits; and,
– Referring cases to law enforcement for consideration and initiation of civil or criminal prosecution.

However, it appears that some of the ZPICs have been overly proactive in identifying the need for payments suspensions and are asking providers to voluntarily agree to payment suspensions for certain claims.

Click here to read more on ZPICs from CMS.

Physicians Being Targeted by ZPICs for Auto-Denial Edits.

Recently, physicians have been approached by ZPICs and asked to voluntarily agree to a payment edit on their National Provider Identifier (NPI) that would automatically deny any claim for payment for home health services that listed the physician as the ordering, attending, or referring physician. A ZPIC requesting a specific physician to voluntarily cease ordering any home health services appears to go further than identifying the need for administrative action including a payment suspension.

The activities a ZPIC may use to fulfil its obligations to CMS are:

– Request medical records and documentation;
– Conduct interviews;
– Conduct onsite visits;
– Identify the need for a prepayment or auto-denial edits and refer these edits to the Medicare Administrative Contractors (MAC) for installation;
– Withhold payments; and,
– Refer cases to law enforcement.

The following functions are reserved for the MACs and not functions of the ZPICs.

– Provider outreach and education;
– Recouping monies lost to the Trust Fund (the ZPICs identify these situations and refer them to the MACs for the recoupment);
– Medical review not
– Complaint screening; for benefit integrity purposes;
– Claims appeals of ZPIC decisions;
– Claim payment determination;
– Claims pricing; and
– Auditing provider cost reports.

While a ZPIC may refer a provider to the MAC for the imposition of an auto-denial edit, some ZPICs seem to have taken this process a step further and are attempting to have physicians voluntarily agree to the auto-denial edits.

Issues with Agreeing to an Auto-Denial Edit.

A physician who voluntarily agrees to an auto-denial edit could create significant problems for his or her patients and practice. A physician agreeing to an auto-denial edit would need to cease ordering home health services and would need to refer the patients that need home health services to another physician. Any physician that has been approached by a ZPIC seeking a voluntary auto-denial edit should consult competent legal counsel before agreeing to the auto-denial edit.

We have heard if ZPIC representatives allegedly intimidating or attempting to intimidate physicians who routinely order home health services for patients into agreeing to such auto-denial edits.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Comments?

Have you heard of these auto-denial edit requests from ZPICs? Please leave any thoughtful comments below.

About the Authors: Michael L. Smith, R.R.T., J.D., is Board Certified by The Florida Bar in Health Law. He is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:00:53-04:00June 1, 2018|Categories: Medicare, The Health Law Firm Blog, ZPIC|Tags: auto-denial edit, Center for Program Integrity (CPI), Centers for Medicare and Medicaid Services, CMS, CMS administrative action, CMS demand letter, CMS intent to refer letter, CPI fraud prevention system, defense attorney, defense lawyer, doctor, fraud defense, fraud prevention, fraud prevention system, health law firm, home health services, legal representation, mac, medical review, medicare, Medicare Administrative Contractor, medicare audit, Medicare audits Florida, Medicare fraud, National Provider Identifier, NPI, overpayment, payment suspensions, physician, recoupment action, the health law firm, Zone Program Integrity Contractor, zpic, ZPIC attorney, zpic audit, ZPIC lawyer|Comments Off

CMS Delays Stage 3 Meaningful Use for Medicare and Medicaid EHR Incentive Programs

By Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law, and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On December 6, 2013, the Centers for Medicare and Medicaid Services (CMS) announced a revised timeline for the implementation of Stage 3 meaningful use measures for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs.

According to CMS, Stage 2 will be extended through 2016, and Stage 3 will begin in 2017 for those hospitals, physicians and other eligible providers that have completed at least two years of Stage 2 meaningful use. These changes affect two groups of eligible providers: providers who started Stage 1 in 2011, and who are currently scheduled to start Stage 3 in 2016, and those providers who started Stage 1 in 2012, and who are scheduled to start Stage 3 in 2016.

This announcement does not change when providers must start Stage 2, nor does it affect the requirement for hospitals and critical access hospitals to upgrade to EHR technology to receive incentive payments. The Medicare and Medicaid EHR incentive programs are staged in three steps with increasing requirements for participation. Eligible providers who do not meet meaningful use requirements will still be penalized with reduced Medicare reimbursement starting January 1, 2015.

To read more from CMS, click here.

Reasons for the Timeline Change.

According to Modern Healthcare, CMS stated that the goal of the timeline change is two-fold. First, to allow CMS and the Office of National Coordinator (ONC) to focus on assisting providers to meet Stage 2 demands for patient engagement, interoperability and information exchange, as well as use data collected during the phase to inform policy decisions for Stage 3.

CMS expects that it will release a notice of proposed rulemaking for Stage 3 in the fall of 2014, and the corresponding ONC notice for proposed rulemaking for the 2017 Edition of the ONC Standards and Certification Criteria will also be released at that time. Click here to read the entire article from Modern Healthcare.

What this Means for You.

If you begin participation with your first year of Stage 1 for the Medicare EHR Incentive Program in 2014:

– You must begin your 90 days of Stage 1 of meaningful use no later than July 1, 2014 and submit attestation by October 1, 2014 in order to avoid the 2015 payment adjustment.

If you have completed one year of Stage 1 of meaningful use:

– You will demonstrate a second year of Stage 1 of meaningful use in 2014 for a three-month reporting period fixed to the quarter for Medicare or any 90 days for Medicaid.
– You will demonstrate Stage 2 of meaningful use for two years (2015 and 2016).
– You will begin Stage 3 of meaningful use in 2017.

If you have completed two or more years of Stage 1 of meaningful use:

– You will still demonstrate Stage 2 of meaningful use in 2014 for a three-month reporting period fixed to the quarter for Medicare or any 90 days for Medicaid.
– You will demonstrate Stage 2 of meaningful use for three years (2014, 2015 and 2016).
– You will begin Stage 3 of meaningful use in 2017.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents physicians and medical groups on EHR issues. It also represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

What do you think of the revised timeline for the implementation of Stage 3 meaningful use? Will this affect you? If so, how? Please leave any thoughtful comments below.

Sources:

Conn, Joseph. “Meaningful-Use Deadline Pushed Back One Year.” Modern Healthcare. (December 6, 2013). From: http://bit.ly/1kkAtsC

Tagalicod, Robert and Reider, Jacob. “Progress on Adoption of Electronic Health Records.” Centers for Medicare and Medicaid Services. (December 13, 2013). From: http://www.cms.gov/eHealth/ListServ_Stage3Implementation.html

About the Authors: Michael L. Smith, R.R.T., J.D., is Board Certified by The Florida Bar in Health Law. He is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. http://www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:00:54-04:00June 1, 2018|Categories: Electronic Health Record, In the Know, The Health Law Firm Blog|Tags: Centers for Medicare and Medicaid Services, certifications, CMS, defense attorney, defense lawyer, EHR, electronic health record incentives, electronic health records, electronic medical record, EMR, health law, health law firm, healthcare, meaningful use, meaningful use deadlines, Meaningful Use Stage 2 incentives, Meaningful Use Stage 3 incentives, meaningful use timeline, medicaid, medicare, MU, Office of the National Coordinator, ONC, the health law firm|Comments Off

Centers for Medicare and Medicaid Services Puts Recovery Audit Contractor Program on Hold

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On February 18, 2014, the Centers for Medicare and Medicaid Services (CMS) announced it is in the procurement process for the next round of Recovery Audit Program contracts. This means the program is, for the time being, on hold while CMS awards new contracts. According to CMS, it will select new vendors to continue the Recovery Audit Contractor (RAC) program, which is responsible for detecting improper Medicare payments. It is expected that this pause will also be used to refine and improve the RAC program. In the announcement it was not disclosed how long the program would be on hold.

Click here to read the announcement from CMS.

This news comes months after CMS revealed an enormous backlog of RAC appeals. The backup is so bad, providers are not able to submit new cases until the existing backlog clears, which could take two years or more.

Current Contracts Extended to Conclude Appeals.

According to Modern Healthcare, CMS extended its contracts with the four current vendors until December 31, 2015, for administrative and transition activities. These contracts were to end on February 7, 2014. The purpose of the extension is to allow the RACs to handle and wind down appeals. To read the entire article from Modern Healthcare, click here.

For providers this means a lull in additional documentation requests (ADRs), however it is important to remember RAC audits are not going away.

Dates to Remember.

Providers should note the important dates below:

– February 21, 2014, was the last day a Recovery Auditor could send a postpayment ADR;
– February 28, 2014, is the last day a Medicare Administrative Contractor (MAC) may send prepayment ADRs for the Recovery Auditor Prepayment Review Demonstration; and
– June 1, 2014, is the last day a Recovery Auditor may send improper payment files to the MACs for adjustment.

Backlog of RAC Appeals Worse Than Ever.

The RAC appeals process has become so overloaded that in December 2013, the U.S. Department of Health and Human Services’ (HHS) Office of Medicare Hearings and Appeals (OMHA) notified hospitals, doctors, nursing homes and other health care providers that the agency would be suspending acting on new requests for hearings. Health care providers were told they would not be able to submit any new appeals until the existing backlog clears, which could take two or more years. To read more on the backlog of RAC appeals, click here for my previous blog.

RAC Audits Will Be Back.

In the first three months of the fiscal year 2013, RACs recouped more than $2.2 billion from providers due to what the RACs deemed were overpayments. With money coming in, RAC audits are not going away. It has become common for state and federal regulators to enforce even the smallest violations, resulting in investigations, monetary fines and penalties. If found in violation, you will not only have to pay fines and face disciplinary action, you will also lose revenue because you will have to spend time dealing with the investigation, instead of practicing medicine. Whether you are trying to prevent Medicare and Medicaid audits, Zone Program Integrity Contractor (ZPIC) audits, or any other kind of healthcare audits, there are steps you can implement in your practice today that may save you down the line. Click here to read more on self audits.

Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Comments?

What do you think about the RAC program being put on hold? What do you think CMS should do to improve the program? Please leave any thoughtful comments below.

Sources:

Kutscher, Beth. “CMS Recovery Audits on Hold as Contractors Wrestle Big Backlog.” Modern Healthcare. (February 20, 2014). From: http://www.modernhealthcare.com/article/20140220/NEWS/302209968/cms-recovery-audits-on-hold-as-contractors-deal-with-big-backlog

Centers for Medicare and Medicaid Services. “Recent Updates.” Centers for Medicare and Medicaid Services. (February 18, 2014). From: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Recent_Updates.html

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2014 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:00:55-04:00June 1, 2018|Categories: In the Know, Medicare, Medicare Audit, The Health Law Firm Blog|Tags: administrative law, audit defense attorney, audit defense lawyer, Centers for Medicare and Medicaid Services, CMS, Connolly Healthcare, false billing, Florida Medicare attorney, Florida Medicare lawyer, health care fraud, health law firm, hhs, how to prepare for a medicare audit, how to prepare for a RAC audit, mac, medicare, Medicare Administrative Contractor, medicare audit, Medicare fraud, Medicare fraud attorney, Medicare investigation, Office of Medicare Hearings and Appeals, OMHA, overbilling, overpayment, prepayment audit, prepayment review, RAC, RAC appeal, RAC appeals backlog, RAC program on hold, Recovery Audit Contractor, self audit, the health law firm, U.S. Department of Health and Human Services, what is a MAC, what is a RAC, who is the RAC for Florida, who is the RAC for region C|Comments Off

OIG Audit Finds Federal Database of Terminated Medicaid Providers Needs Improvement

By Lenis L. Archer, J.D., M.P.H., The Health Law Firm

The Affordable Care Act (ACA) requires the Centers for Medicare and Medicaid Services (CMS) to establish a process for sharing information about terminated Medicaid providers. The federal database, called Medicaid and Children’s Health Insurance Program State Information Sharing System (MCSIS), is designed to prevent terminated health care providers from billing another state’s program. However, an audit by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG), released in March 2014, states the MCSIS is not working as intended.

The MCSIS is supposed to collect data from every state Medicaid program on providers that were terminated from Medicaid for cause. However, the report found that the HHS OIG is not receiving data from 17 states or the District of Columbia. It was also found that a majority of the data does not meet the ACA criteria.

To read the entire report from the HHS OIG, click here.

Specific Issues Within Database.

According to the OIG, only 27% of the 6,439 MCSIS records involve terminated Medicaid providers. The database is filled with providers who had not been terminated, but rather had died, retired, left the state or stopped working with Medicaid of their own accord. It is also reported that about one-third of the records are not related to for-cause provider terminations. A majority of the data comes from California, Pennsylvania, Illinois and New York. According to Reuters, more than half of the records submitted did not include a National Provider Identification number, which is critical to any state trying to identify a terminated provider.

Click here to read the entire article from Reuters.

Recommendations to Improve Database.

CMS is now exploring options to implement mandatory state reporting. The agency has begun requiring that states submit termination letters for each provider entered in the MCSIS, and that CMS employees review each letter to ensure the provider belongs in the system.

What This Means for Medicaid Providers.

As CMS works to improve this database, those providers who have fallen through the cracks due to the reporting lag will now face repercussions for exclusion. Exclusion from Medicaid could mean exclusion from Medicare and other federal providers. It is important that health care providers know their status regarding exclusion, and contact an experience attorneys to assist them in having their names removed from exclusion lists.

To read more on the devastating consequences of exclusion, click here for a previous blog.

Contact Attorneys Experienced in Defending Against Action to Exclude an Individual or Business from the Medicare or Medicaid Programs.

The attorneys of The Health Law Firm have experience in dealing with the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS), and defending against action to exclude an individual or business entity from the Medicare or Medicaid Programs, in administrative hearings on this type of action, in submitting applications requesting reinstatement to the Medicare Program after exclusion, and removal from the List of Excluded Individuals and Entities (LEIE).

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Comments?

As a health care provider, do you know your status regarding exclusion? Are you aware of the consequences of being excluded? Please leave any thoughtful comments below.

Sources:

Pell, M.B. “U.S Database for Tracking Medicaid Fraud Fall Short, Auditor Says.” Reuters. (March 27, 2014). From: http://www.reuters.com/article/2014/03/27/us-usa-medicaid-database-idUSBREA2Q08D20140327

Levinson, Daniel. “CMS’s Process for Sharing Information About Terminated Providers Needs Improvement.” Department of Health and Human Service Office of Inspector General. (March 2014). From: http://oig.hhs.gov/oei/reports/oei-06-12-00031.pdf

About the Author: Lenis L. Archer is as attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2014 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:00:56-04:00June 1, 2018|Categories: Department of Health, Health Care Industry, MCSIS, Medicaid, Medicaid audit, Our Firm, The Health Law Firm Blog|Tags: ACA, Affordable Care Act, audit, billing Medicaid, Centers for Medicare and Medicaid Services, CMS, defense attorney, defense lawyer, Department of Health and Human Services, excluded from Medicaid, health law firm, hhs, medicaid, Medicaid and Children's Health Insurance Program State Information Sharing System, Medicaid provider, Office of Inspector General, OIG, OIG audit, terminated from Medicaid, the health law firm|Comments Off

Say Goodbye to Physicians United Plan and Hello to Changes

By Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law

As of July 1, 2014, at 12:01 a.m., Physicians United Plan (PUP) will be liquidated. The insurance company was declared insolvent by a Florida circuit judge in Tallahassee on June 9, 2013. The judge turned the company over to the Florida Chief Financial Officer for immediate control of the company’s property and assets.

PUP is a Medicare Advantage plan, which is a private insurance company that insures Medicare patients. The Orlando, Florida-based company reports having 38,000 insurance subscribers. Those members have been switched back to original Medicare and a Part D prescription drug plan to avoid losing coverage during the transition. PUP subscribers will have to move to a new plan this fall if they want to stay with the Medicare Advantage program.

Click here to read the letter from the Department of Financial Services on the transition of patients from PUP to Medicare.

Background on the PUP Liquidation.

PUP failed to raise a required $30 million by the June 3, 2014, a deadline set to meet the state’s guidelines for financial solvency of an insurance company. The court order allows Florida’s Chief Financial Officer to “take immediate possession of all the property, assets and estate, and all other property of every kind whatsoever and wherever located.” PUP agreed to allow the Florida Division of Financial Services to become its court-appointed receiver on April 16, 2014.

To read the consent order appointing the Florida Department of Financial Services as the receiver of PUP, click here.

How Will This Affect Hospitals and Medical Providers?

If a medical group had a capitated plan, PUP should have been paying the physician group a set amount each month to keep its patients healthy. These groups won’t be hit as hard as others. However, more than 87 percent of PUP doctors were on fee-for-service contracts with PUP. These providers are more likely to get paid 20 to 30 percent of their outstanding bills after liquidation.

What to Say When a PUP Patient Comes Into Your Office.

After PUP was placed under the state’s control, patients reported health care providers have been canceling their appointments, canceling procedures and not filling their prescriptions. So on June 13, 2014, the Department of Financial Services sent a stern letter to health care providers warning them to continue taking patients with PUP. The letter stated: “Refusal of care, cancellation of appointments and any similar activities impacting member care form the basis of nonpayment of services and other state action.” To read the warning letter from the Florida Department of Financial Services to health care providers, click here.

On June 16, 2014, the Department of Financial Services advised health care providers to submit the claims to Medicare for prompt payment after June 23, 2014.

Comments?

What do you think about the liquidation of PUP? Do you think it will have an affect on your practice? Do you have any hesitations about PUP being liquidated? Please leave any thoughtful comments below.

Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents physicians and medical groups in insurance issues. It also represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Powers, Scott. “PUP Customers Must Find New Medicare Plans.” Orlando Sentinel. (June 9, 2014). From: http://www.orlandosentinel.com/business/os-state-shutting-down-medicare-insurer-20140609,0,2911253.story

Aboraya, Abraham. “Judge Approves Liquidating Physicians Unite Plan on July 1.” Orlando Business Journal. (June 9, 2014). From: http://www.bizjournals.com/orlando/blog/2014/06/judge-approves-liquidating-physicians-united-plan.html

Shedden, Mary. “Don’t Abandon PUP Patients: State.” Health News Florida. (June 13, 2014). From: http://bit.ly/1lt8WoA

About the Author: Michael L. Smith, R.R.T., J.D., is Board Certified by The Florida Bar in Health Law. He is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:00:57-04:00June 1, 2018|Categories: In the News, The Health Law Firm Blog|Tags: capitate plan, Centers for Medicare and Medicaid Services, fee-for-service contract, Florida Department of Financial Services, medicaid, Medicare Advantage Insurance, physician group, Physicians United, Physicians United Plan, Physicians United Plan contracts, PUP, PUP contracts, PUP doctor, PUP liquidation, PUP patients, PUP policy holders|Comments Off

CMS in the Hot Seat for Lax Oversight of Medicaid Managed Care Organizations

By Lenis L. Archer, J.D., M.P.H., The Health Law Firm

For years, each state has kept an eye on its own Medicaid managed care plans, while the Centers for Medicare and Medicaid Services (CMS) is required to monitor how well each individual state is doing. However, a recent Government Accountability Office (GAO) report claims CMS is sleeping on the job. The report, released on June 20, 2014, stresses the need for more federal oversight of these plans.

With the implementation of the Affordable Care Act (ACA), the Medicaid program is expected to expand significantly. Most of the new beneficiaries enrolled in managed care are covered almost entirely by federal funds. The need for federal oversight in this area is of growing importance to ensure accountability of taxpayers’ dollars.

To read the entire report from the GAO, click here.

Report Findings: MCOs Need to be Watched by the Feds.

The persistent theme of the GAO report is that CMS and the Department of Health and Human Services (HHS) have done little to control the integrity of managed care organizations (MCOs). Federal programs have delegated managed care supervision to each individual state, but fail to provide needed guidelines and resources. CMS has not updated its MCO program guidance since 2000.

The report found neither state nor federal programs are well positioned to identify improper payments made to MCOs. Further, these programs are unable to ensure that MCOs are taking appropriate actions to identify, prevent or discourage improper payments.

For example, the report looked at state program integrity (PI) units and Medicaid Fraud Control Units (MFCU) from seven states. These anti-fraud groups admitted to primarily focusing their efforts on Medicaid fee-for-service claims. Meanwhile, claims made to MCOs have flown under their radar.

GAO Recommendations.

The GAO recommends that CMS:

– Require states to conduct audits of payments to and by MCOs;

– Update its managed care guidance program integrity practices and effective handling of MCO recoveries; and

– Provide states with additional support in overseeing MCO program integrity.

The GAO also suggests that CMS increase its oversight, especially as states expand their Medicaid programs. The GAO report recommends CMS take a bigger role in holding states accountable to ensure adequate program integrity efforts in the Medicaid managed care program. If CMS does not step up to the plate, the report predicts a growing number of federal Medicaid dollars will become vulnerable to improper payments.

The Future of MCOs.

If this report is taken seriously, be assured that audits of MCOs will become more frequent and extensive. If CMS ramps up their efforts, claims could be reviewed in detail by Medicaid integrity contractors. Now is the time to verify you are in compliance and receiving proper payments; before CMS turns the magnifying glass on you or your facility .

Comments?

What do you think of the GAO’s assessment of MCOs? Do you think CMS needs to step up and provide more oversight? Please leave any thoughtful comments below.

Contact Health Law Attorneys Experienced in Handling Medicaid Audits, Investigations and other Legal Proceedings.

Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Health Care Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, and the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS). Other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies often participate. Don’t wait until it’s too late. If you are concerned about possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.

The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions. To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com .

Sources:

Mullaney, Tim. “Federal Government Needs to Boost Medicaid Managed Care Oversight, GAO Says.” McKnight’s Long-Term Care & Assisted Living. (June 20, 2014). From: http://www.mcknights.com/federal-government-needs-to-boost-medicaid-managed-care-oversight-gao-says/article/356779/

Adamopoulos, Helen. “GAI Calls on CMS to Increase Medicaid Managed Care Oversight.” Becker’s Hospital Review. (June 20, 2014). From: http://www.beckershospitalreview.com/finance/gao-calls-on-cms-to-increase-medicaid-managed-care-oversight.html

Bergal, Jenni. “Advocates Urge More Government Oversight of Medicaid Managed Care.” Kaiser Health News. (July 5, 2013). From: http://www.kaiserhealthnews.org/stories/2013/july/05/medicaid-managed-care-states-quality.aspx?referrer=search

About the Author: Lenis L. Archer is as attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

By The Health Law Firm|2024-03-14T10:00:57-04:00June 1, 2018|Categories: Department of Health and Human Services, GAO, Government Accountability Office, Health Care Industry, HHS, In the Know, In the News, MCO, Medicaid, Medicaid managed care, Medicare, The Health Law Firm Blog|Tags: ACA, Affordable Care Act, auditing payments to MCO, Centers for Medicare and Medicaid Services, CMS, CMS oversight, Department of Health and Humans Services, GAO investigation, health law firm, hhs, improper payments, managed care insurance, managed care plan, managed care services, MCO managed care, medicaid, Medicaid defense attorney, Medicaid defense lawyer, Medicaid managed care organization, Medicaid payments, Medicaid programs, Patient Protection and Affordable Care Act, the health law firm|Comments Off