Friday, July 12, 2013

The "Random Audit" Power of Obamacare Enforcers

These pages have documented my disdain and abhorrence of Obamacare since its inception, all to no avail. Today's guest blogger is my brother, Jon, who wrote in November 2012 on election eve about his concerns for the implementation of Obamacare and its impact on the small family group practice where he is the Chief Executive. 

Today he updates us with another real-life example of the impact of the enforcement arm of Obamacare and what seems to be the Obama administration's scheme to extract penalties through audits from the healthcare practitioners who have complied in good faith.  

He writes:

The double standard of the current administration is all too obvious… the business of healthcare has become dirty politics.

Dr. Obama knows all
Whether we know it or not thousands of doctor’s offices throughout America are now considered corrupt institutions according to the Obama administration. Recently, I was made aware that a local medical group of about 15 dedicated physicians were notified that an audit of their corporate books is in their immediate future. This medical group is a reputable institution with an excellent reputation for appropriate medical care to their patients. 

Like many of their peer organizations they qualified for Meaningful Use incentive payments for the proper use and configuration of their electronic medical record (EMR) system. The incentive performance payments are directly tied to quality standards and regulations as dictated by the administration (who know nothing about dispensing medical care) as a way to streamline, automate and create quality benchmarks – all in an effort to lower the cost and improve the quality of healthcare. 

These incentives are offered to physicians during a four-year period. The original intent was to put enough incentive money in the hands of physicians to facilitate the purchase of new servers, networking, printers, scanners, laptops or iPads and to pay IT professionals to configure the new systems. No doubt many of the classic medical group activities are improved through the adoption of an EMR as a direct result of the annual payments to each physician that can range from $5,000 to $18,000.  

There are severe financial penalties beginning in 2015 for physicians who do not adopt an EMR. One of those major penalties that could be imposed is an exclusion from the Medicare program at a time when, according to AARP, nearly 8,000 new people per day qualify for Medicare.

In addition to the Meaningful Use incentives, Medicare has a similar approach in that they will incentivize physicians to adopt new ways of reporting (e-file claims instead of faxing or mail) and transmitting secure prescriptions (known as e-prescribing) directly to your pharmacy. In Medicare’s incentive package they structured it to be a 2% add-on to the claim reimbursement for the first year; 1.5% the second year; and in subsequent years Medicare would deduct up to 2% if physicians could not demonstrate that they had fully adopted the new transmission technique. Essentially, if you don’t adopt the only way we have given you to participate, you will be penalized.

Back to the medical group of 15 physicians. After having worked hard to navigate through the numerous and stringent Meaningful Use regulations, carefully measuring their hourly compliance to the mandated quality standards, logging hours of analysis of performance reports by physicians, changing daily behaviors in how and when the physicians treat their patients, they submitted their results to the administration and expected payment for their compliance. 

Payments were received within six weeks. Fast-forward about six months from receipt of payments, and this same medical group has now received a certified letter from a local regulatory agency with the news they have been selected for a “random” audit. They were selected as part of their 10% compliance requirement from the current administration. 

Healthcare insiders have come to understand the word “random” in these types of letters is really bureaucratic doublespeak for the real meaning of “show me the money” and, “did you do what we think you ought to do with it?”

The incentive payments had been received and funds disbursed to the physicians, IT professionals, hardware vendors and staff. All the appropriate payroll and income taxes were paid on the incentive funds. When the monies were placed in the bank account of the medical group there was no mention or stipulation that Uncle Sam would be lurking about to see what they would do with the money, nor were there any rules that stated the funds received must be funneled through only authorized ledger line items of the private corporations who met all the criteria. 

In similar instances to the receipt of the audit notice of the 15 physician medical group, regulatory auditors will often times arrive with a scope of work in mind and they draw their own subjective conclusions to a medical group’s compliance that may be much different to the understanding that the EMR software vendor had when they created the code for the often ambiguous regulation and/or the understanding that a physician uses to measure his compliance to new behaviors during the attestation periods. 

A medical group being audited has no appeal against the mandate of the old adage: “He who owns the purse strings makes the rules… according to his own desires.” 

While the final chapter has yet to be written in the case of the group of 15 physicians who have received their notice of “random” audit selection, many other similar groups, ours included, have been examined under the “random audit” nomenclature and been required to refund to regulatory agencies cash that was rightfully and honestly earned.

The overreach of these “random” audits are routinely conducted under the justification that the administration holds the right to enter any private corporation in America with the intent that we all “follow the rules” according to those who preside over and pay for mandated compliance. How many times do we hear from Mr. Obama’s lips that everyone has to follow the same set of (his) rules in order for (his) plan to work – and then when our vote against (his) rules does not match-up to his we must suffer his scorn at the bully pulpit? 

Once inside the doors of Main Street businesses like your doctor’s office, regulatory compliance auditors will often jump the fence of the original scope of their audit to request additional records and therein find other subjective infractions of the “rules” that may or may not apply to the initial audit scope. Refusal is a futile effort, since the physicians who received incentive funds with honorable intent did their best to comply to the often-shifting regulatory definitions of Meaningful Use as defined by the current administration. 

The obdurate juggernaut of social policy-making from inside the beltway has now spilled over into the exam rooms of our local doctor’s office, whether we like it or not.

While the final chapter of the audit has yet to be written for the medical group of 15 physicians even though they reported to the regulatory agency their honest effort at full compliance to Meaningful Use regulations, they are certain they will be forced to forfeit some of the funds they earned under the guise of an incentive payment from the government for what once purported to be a "cost-reduction" piece of legislation now known derisively as "Obamacare." Once those funds were dangled in front of them to become more automated and efficient and they complied in a good faith effort, the threat now exists they will be reclaimed through a regulatory power play. All in the name of decreasing medical costs and improving quality. Yikes!

With my eyes wide open that I may be next for a “random” audit …

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Let's hope the NSA isn't reading The Goates Notes, Jon - we'll see if free speech in America is still a valid 1st Amendment right or if you're pushing the envelope of freedom a little too far.

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