Tag:

medicare

Electronic Health Record Compliance Measures Benefit Patient Centered Care

In a time when data breaches occur fairly frequently, whether it’s credit card information being stolen from department stores or a credit reporting bureau breach affecting hundreds of millions of customers, keeping personal information private seems to get harder every day. That fact may give patients pause when they are asked to sign up for an electronic health record account. A 2017 survey listed electronic health record management as one of patients top concerns. Changes in recent years have led to changes in compliance measures that make electronic health records security an added benefit to patients and ensure the continued increase of their adoption.

Newly Added Regional Medicare Fraud Strike Force Targets Opioid Crisis

One month after the largest health care fraud enforcement action was taken, the Assistant Attorney General, Brian A. Benczkowski, of the Justice Department’s Criminal Division, announced the addition of the Newark/Philadelphia Regional Medicare Strike Force. The newly added 11th Medicare Strike Force will largely focus on healthcare fraud that is contributing to the opioid epidemic.

My Summer with the Office of Inspector General for the U.S. Department of Health and Human Services

This summer I had the opportunity to intern with the Office of Inspector General for the U.S. Department of Health and Human Services (OIG) in Washington, DC. I thoroughly enjoyed my time with OIG, and I learned a great deal about health care fraud, waste, and abuse. In spending my summer with OIG, I had a glimpse into the powerful regulatory bodies that protect the health care market from abuse. As I move forward with my career in regulatory work, I will take with me the invaluable experiences and skills from my internship.

DOJ Joins Whistleblower Suit Against UnitedHealth Group

The United States Department of Justice (“DOJ”) recently intervened in a qui tam action against UnitedHealth Group (“United”) and its subsidiary, UnitedHealthcare Medicare & Retirement, the nation’s largest provider of Medicare Advantage (“MA”) Plans. The suit alleges that United engaged in an “up-coding” scheme to receive higher payments than they should have under MA’s risk adjustment program. Assuming these allegations of United’s false claims are true, then United billed and received hundreds of millions of dollars in improper payments from Medicare.

Mother and Son Sentenced to Federal Prison for Pharmacy Fraud Scheme

Anais Holland-Rudd Associate Editor Loyola University Chicago School of Law, JD 2018   Niurka Fernandez, 54, and her son Roberto Alvarez, 26, both plead guilty on August 31, 2016 to one count of conspiracy to commit health care fraud. On November 10th, Fernandez was sentenced to 120 months in prison while Alvarez was sentenced to …
Read more

MACRA 101: Noteworthy Changes in the Final Rule

Alanna Kroeker Executive Editor Loyola University Chicago School of Law, JD 2017   As our MACRA 101 series comes to an end, this article is intended to point out key differences between the proposed rule released earlier this year and the final rule which was released October 14th.  The lengthy final rule, reaching almost 2,400 …
Read more

MACRA 101: Advanced Alternative Payment Models

Bherti Patel Associate Editor Loyola University Chicago School of Law, JD 2018   The Quality Payment Program (QPP) will reward delivery of quality patient care through the following two programs: the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs). These two programs will allow clinicians and physicians to provide care in a …
Read more

MACRA 101: MIPS and the Clinical Practice Improvement Reporting Category

Christine Bulgozdi Associate Editor Loyola University Chicago School of Law, JD 2018   The Merit-based Incentive Payment System (“MIPS”) is one of the two different payment methods that MACRA will use for eligible clinicians. Clinicians will be evaluated based on a single Composite Performance Score from four reporting categories: Quality, Resource Use, Advancing Care Information and …
Read more

MACRA 101: MIPS and the Advancing Care Information Category

Alanna Kroeker Executive Editor Loyola University Chicago School of Law, JD 2017   This article will spell out the details for the Advancing Care Information (ACI) category of the Merit Based Incentive Payment System (MIPS).  This category accounts for 25% of a clinician’s overall composite score and is intended to replace the current Meaningful Use …
Read more

MACRA 101: MIPS and the Resource Use Category

Bherti Patel Associate Editor Loyola University Chicago School of Law, JD 2018   As previously discussed, MIPS will streamline Medicare’s current quality measures into one composite score from four reporting categories: Quality, Resource Use, Advancing Care Information, and Clinical Practice Improvement. This score will then be used to determine the reimbursement to a clinician based …
Read more