Insights

Washington, D.C. – January 17, 2013: Crowell & Moring LLP is pleased to announce it has elected seven attorneys to the firm's partnership effective January 1, 2013. The firm has also promoted three attorneys to the position of senior counsel, and nine associates to the position of counsel. The new partners, senior counsel, and counsel have been promoted from within the ranks of the firm's Washington, D.C., San Francisco, Brussels, and London offices.

Hospitals that participated in the Medicare Electronic Health Records (EHR) Incentive Program (also known as the Meaningful Use Program) will be the subject of a national audit by the Department of Health and Human Services, Office of the Inspector General (OIG). Under the Medicare Meaningful Use Program, the Centers for Medicare & Medicaid Services (CMS) made EHR incentive payments to hospitals totaling $14.6 billion. The OIG review is focusing on hospitals that received Medicare EHR incentive payments between January 1, 2011 and December 31, 2016.

The Centers for Medicare and Medicaid Services (CMS) has spent billions of dollars to encourage the meaningful use of electronic health records (EHR). In a recent audit report, the Department of Health and Human Services, Office of the Inspector General (OIG) estimated that CMS improperly paid more than $729 million in EHR incentives to professionals during the initial years of the EHR incentive. These findings highlight a potential area for significant overpayment recovery actions that could pose certain risks for recipients of incentive payments.

On Friday, October 14, 2016, the Centers for Medicare and Medicaid Services (CMS) released the pre-publication version of the final rule with comment period (Final Rule) that, beginning January 1, 2017, will implement the provisions of the Medicare Access and CHIP Reauthorization Act (MACRA) relating to the new Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). MIPS and APMs are collectively referred to as the “Quality Payment Program” or “QPP”. Physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists (collectively, “MIPS-eligible clinicians”) are part of the QPP if they bill Medicare more than $30,000 a year or provide care for more than 100 Medicare patients a year (both higher thresholds than initially proposed by CMS in the notice of proposed rulemaking).

Troy Barsky, a Washington, D.C.-based partner in the firm's Health Care Group, explains recent legislation designed to repeal the sustainable growth rate (SGR) formula for physician reimbursement, as well as provisions echoing the fraud and abuse mandates in the Affordable Care Act. "This is a strong message from Congress that the focus on fraud and abuse is here today," Barsky said. "The bill was supposed to focus on physician payments, but…having a strong compliance program is vitally important if you continue to operate in this space."

Payers, Providers, and Patients – Oh My! is Crowell & Moring’s health care podcast, discussing legal and regulatory issues that affect health care entities’ in-house counsel, executives, and investors.