Figliozzi and Company Meaningful Use Audits – CMS Designee Can Take Back Incentive Funds

Figliozzi and Company Meaningful Use Audits of health care providers that attested to Meaningful Use for Stage 1 are being led by Figliozzi and Company, the  CMS designee to perform audits for the EHR Incentive Program (the “Program” or “Meaningful Use Program”).  The letters are requesting  records related to the attestation by Eligible Providers (“EP”).  The American Recovery and Reinvestment Act (ARRA) provides statutory authority for these audits.  See Meaningful Use Audit Defense.

Despite  recent writings by some law firms, a failed Meaningful Use audit (“final determination”) by Figliozzi is a serious affair,  requiring the attesting organization to immediately pay 100% of the Meaningful Use incentive funds back to CMS.  For a $500 million hospital system, for example, this is likely to be $millions.

The letters from Figliozzi and Company may request:

  • A  copy of the Eligible Provider’s certification from the ONC for the technology they used to meet Meaningful Use Stage 1.
  • Documentation to support the observation method chosen (observation services or all emergency department visits).  This method is used in determinations of which  which patients were included in the denominators of meaningful use core and menu items.
  • Supporting documentation for the attestation module Core Measures and Objectives.
  • Supporting documentation for the attestation module responses as to Menu Set objectives and measures.

A meaningful use audit defense strategy would include being prepared to demonstrate in-depth inquiries regarding structured, discrete data.  In addition, audited entities should be prepared to discuss all Core Measures including Computerized Physician Order Entry (CPOE), drug interaction checks enabled, problem lists, and other areas such as CQM and discharge.  Also, up to five Meaningful Use Stage 1 Menu Items and 15 clinical quality measures.

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Michael F. Arrigo

Michael Arrigo, an expert witness, and healthcare executive, brings four decades of experience in the software, financial services, and healthcare industries. In 2000, Mr. Arrigo founded No World Borders, a healthcare data, regulations, and economics firm with clients in the pharmaceutical, medical device, hospital, surgical center, physician group, diagnostic imaging, genetic testing, health I.T., and health insurance markets. His expertise spans the federal health programs Medicare and Medicaid and private insurance. He advises Medicare Advantage Organizations that provide health insurance under Part C of the Medicare Act. Mr. Arrigo serves as an expert witness regarding medical coding and billing, fraud damages, and electronic health record software for the U.S. Department of Justice. He has valued well over $1 billion in medical billings in personal injury liens, malpractice, and insurance fraud cases. The U.S. Court of Appeals considered Mr. Arrigo's opinion regarding loss amounts, vacating, and remanding sentencing in a fraud case. Mr. Arrigo provides expertise in the Medicare Secondary Payer Act, Medicare LCDs, anti-trust litigation, medical intellectual property and trade secrets, HIPAA privacy, health care electronic claim data Standards, physician compensation, Anti-Kickback Statute, Stark law, the Affordable Care Act, False Claims Act, and the ARRA HITECH Act. Arrigo advises investors on merger and acquisition (M&A) diligence in the healthcare industry on transactions cumulatively valued at over $1 billion. Mr. Arrigo spent over ten years in Silicon Valley software firms in roles from Product Manager to CEO. He was product manager for a leading-edge database technology joint venture that became commercialized as Microsoft SQL Server, Vice President of Marketing for a software company when it grew from under $2 million in revenue to a $50 million acquisition by a company now merged into Cincom Systems, hired by private equity investors to serve as Vice President of Marketing for a secure email software company until its acquisition and multi $million investor exit by a company now merged into Axway Software S.A. (Euronext: AXW.PA), and CEO of one of the first cloud-based billing software companies, licensing its technology to Citrix Systems (NASDAQ: CTXS). Later, before entering the healthcare industry, he joined Fortune 500 company Fidelity National Financial (NYSE: FNF) as a Vice President, overseeing eCommerce solutions for the mortgage banking industry. While serving as a Vice President at Fortune 500 company First American Financial (NYSE: FAF), he oversaw eCommerce and regulatory compliance technology initiatives for the top ten mortgage banks and led the Sarbanes Oxley Act Section 302 internal controls I.T. audit for the company, supporting Section 404 of the Sarbanes Oxley Act. Mr. Arrigo earned his Bachelor of Science in Business Administration from the University of Southern California. Before that, he studied computer science, statistics, and economics at the University of California, Irvine. His post-graduate studies include biomedical ethics at Harvard Medical School, biomedical informatics at Stanford Medical School, blockchain and crypto-economics at the Massachusetts Institute of Technology, and training as a Certified Professional Medical Auditor (CPMA). Mr. Arrigo is qualified to serve as a director due to his experience in healthcare data, regulations, and economics, his leadership roles in software and financial services public companies, and his healthcare M&A diligence and public company regulatory experience. Mr. Arrigo is quoted in The Wall Street Journal, Fortune Magazine, Kaiser Health News, Consumer Affairs, National Public Radio (NPR), NBC News Houston, USA Today / Milwaukee Journal Sentinel, Medical Economics, Capitol ForumThe Daily Beast, the Lund Report, Inside Higher Ed, New England Psychologist, and other press and media outlets. He authored a peer-reviewed article regarding clinical documentation quality to support accurate medical coding, billing, and good patient care, published by Healthcare Financial Management Association (HFMA) and published in Healthcare I.T. News. Mr. Arrigo serves as a member of the board of directors of a publicly traded company in the healthcare and data analytics industry, where his duties include: member, audit committee; chair, compensation committee; member, special committee.

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