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 is Managing Partner & CEO of No World Borders, a leading healthcare management and IT consulting firm. He serves as an expert witness in Federal and State Court and was recently ruled as an expert by a 9th Circuit Federal Judge. He serves as a patent expert witness on intellectual property disputes, both as a Technical Expert and a Damages expert. His vision for the firm is to continue acquisition of skills and technology that support the intersection of clinical data and administrative health data where the eligibility for medically necessary care is determined. He leads a team that provides litigation consulting as well as advisory regarding medical coding, medical billing, medical bill review and HIPAA Privacy and Security best practices for healthcare clients, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, physician compensation, Insurance bad faith, payor-provider disputes, ERISA plan-third-party administrator disputes, third-party liability, and the Medicare Secondary Payer Act (MSPA) MMSEA Section 111 reporting. He uses these skills in disputes regarding the valuation of pharmaceuticals and drug costs and in the review and audit of pain management and opioid prescribers under state Standards and the Controlled Substances Act. He consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises ERISA self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $8 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, studies at Stanford Medical School - Biomedical Informatics, studies at Harvard Medical School - Bioethics. Trained in over 10 medical specialties in medical billing and coding. Trained by U.S. Patent and Trademark Office (USPTO) and PTAB Judges on patent statutes, rules and case law (as a non-attorney to better advise clients on Technical and Damages aspects of patent construction and claims). Mr. Arrigo has been interviewed quoted in the Wall Street Journal, New York Times, and National Public Radio, Fortune, KNX 1070 Radio, Kaiser Health News, NBC Television News, The Capitol Forum and other media outlets. See https://www.noworldborders.com/news/ and https://www.noworldborders.com/clients/ for more about the company.

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