The CMS is increasingly turning its attention to audits of electronic health-record use, she said. The CMS wants to know "how it is working and are some using it to game the system."
Veering slightly off legal and compliance topics, Judge expressed concern that some systems that implemented EHRs and were paid for meaningful use are now abandoning them because they are too complicated and drain facility's resources. She stressed that that was a bad strategic decision for a hospital. "Please stick with it," she said.
Also on the EHR front, Judge mentioned cases of the Office of the National Coordinator recently removing the certifications of two EHR vendors. The ONC wants provider executives to be extra careful when choosing this technology solution. "You want to be with a company that is financially solid," because if it goes out of business you could face legal and compliance issues on a host of levels, she warned.
When discussing Medicare fraud and abuse, Judge was adamant that providers could expect more audits in the future. From 2010-2012, every dollar the government spent on fraud investigations and recovery audits removed $7.90 from provider payments. "Most of us would like $8 on every $1, so these will continue to roll forward," she said.
Fraud investigators are increasingly turning to predictive modeling and monitoring social networking, Judge explained, which uses electronic data links to determine who is involved in fraud and abuse.
Judge also gave several examples in which quality of care issues, and not financial malfeasance, were the basis for fraud and abuse litigation, a trend she believes will continue.
Antitrust issues are "the most frustrating part of the law to me right now," she said. Systems are being enticed to consolidate for reasons of efficiency and scale in the wake of the healthcare reform law, yet the FTC is enforcing antitrust laws with "new vigor" and paying special attention to the rules.
In such a complicated environment, Judge underscored the importance of providers staying focused on compliance and all of its various components. She said that too many compliance programs are put into place but that those programs are not vetted and updated on a regular basis, which can cause serious issues in such a fluid and changing legal environment.
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