Because of the new emphasis on linking health care provider compensation to quality, compliance teams will have to think more about quality measurement.
Daniel Levinson, the inspector general of the U.S. Department of Health and Human Services, made that prediction earlier this month during a meeting organized by the Health Care Compliance Association, Minneapolis, according to a summary posted on the HHS inspector general’s website.
The new federal Affordable Care Act – a package that includes the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act – ties some payments to physicians, hospitals and other care providers to the quality of care provided, Levinson said.
The new rules “may require health care providers to implement new systems to track and accurately report performance measures,” Levinson said, according to the summary of his speech.
The boards of organizations that provide care and are responsible for tracking quality will have to become more active in monitoring quality, Levinson said.
The HHS Office of the Inspector General will work to help compliance professionals and board members meet their quality compliance responsibilities by working with professional groups to hold forums and publish guides, Levinson said.
Also during the speech, Levinson talked about other Medicare compliance issues.
In some cases, “viral” Medicare fraud schemes are replicating rapidly through ethnic and geographic communities, and, in some cases “violent criminals” are infiltrating the Medicare program, Levinson said.
In some cases, Levinson said, sham providers defraud Medicare by masquerading as legitimate providers.