Electronic health record (EHR) vendor eClinicalWorks (eCW) recently entered into a settlement with the US Department of Justice (DOJ) and the Department of Health and Human Services’ Office of Inspector General (OIG) to resolve allegations under the federal False Claims Act (FCA) that eCW misrepresented its software and paid customers kickbacks to promote its products. The settlement imposes joint and several liability for payment on the EHR Vendor and three of its founders for $154.92 million, and liability for settlement payments individually by a developer ($50,000) and two project managers ($15,000 each). The settlement resolves a qui tam whistleblower action and the government’s complaint-in-intervention in United States ex rel. Delaney v. eClinicalWorks LLC, 2:15-CV-00095 (D. Vt.).
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CMS Issues Proposed IPPS Rule
By Robinson+Cole's Health Law Group on
On April 14, 2017, the Centers for Medicare & Medicaid Services (CMS) released the FY 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) Prospective Payment System (PPS) Proposed Rule, and Request for Information (Proposed Rule). The Proposed Rule outlines proposed updates to Medicare payment rates under the Inpatient Prospective Payment System (IPPS) and policies for hospital admissions. The goals of the Proposed Rule include relieving regulatory burdens on providers, supporting the doctor-patient relationship, and promoting transparency, flexibility, and innovation in the delivery of care.
CMS is also soliciting ideas for regulatory, policy, practice and procedural changes to better achieve transparency, flexibility, program simplification and innovation through a Request for Information (RFI). The RFI is seeking clear, concise proposals to encourage the development of a new Medicare delivery system to reduce existing burdens for clinicians, providers and patients, while increasing effectiveness and decreasing costs. Proposals must include data and specific examples, and if applicable, should address CMS’ authority to implement such proposals. CMS does not plan to respond to RFI comments, but will consider them in developing future regulatory proposals or guidance.
The IPPS was established under § 1886(d) of the Social Security Act and utilizes a national base payment rate for inpatient hospital stays, adjusted for factors such as patient conditions and the cost of hospital labor depending on geographic area. CMS is required to issue annual updates for IPPS hospital payment rates. The Proposed Rule would affect hospital and LTCH payments for discharges occurring on or after October 1, 2017.
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